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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Sute Fortn 43709 (RS / 6-03)
PmscnbeE by Departmem of Local Guvemment Finance
Coun Township Year
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INSTRUCTIONS: '�AN O F;�4,Qa�
To be filed in person or 6y mail with the County Auditor ol the county wheie Ihe property is located.
Filing Dates: 1) Real Property: During the 12 months be/ore May 11 of the year the deduction is to be e ,(���+�!��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the��gaz !hg uducyb u�OR eRective.
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See reverse side for additional instructions and qualifrcations. r
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Applica (owner pr contract buy - ee restrictions on reve i)
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Taxing Distrid . Key number / legal description Record number ��
��y,n - / OD � _ O/ �/ ' � Page number �
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Assessed value of real property as of MoRgage / Contrad indebledness unpaid as of Is the applicant ihe sol legal or equitable
March 1, wrrent year March 1, current year owne(? ❑ Yes ❑ No
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If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than lhat of applicant, indicate below: Is the property in question:
❑ Real Property p Moale Home QC 61.1-�
�e of mortgagee or contract seller �j
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Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for wrrent year?�] Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �i _ 20 07 20 D� 20 20 20 20
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Signature County Auditor Date
We certify under the penalty of perjury lhat the above and foregoing information is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Si alnure (owners (ull name) Person authorized by duly executed Power of Attomey
���J ��� or by IC 6-1.1-12-.07
Full resident address of applipnt Address of authorized person
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