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� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S / Stata Form 43709 (RS / 4-03) � , � �
� �«
Presaibed by Departmeni of local Govemment Finance
iNSrRUCrioNS: FEB 2 8 2007 File Mark
To be filed in person or 6y mail with the CountyAuditor of the county where the propeRy is located.
Filing Dafes: 1) Real Property: During lhe 12 months before May 11 0/ the year the deduction is �' ke ef#eohYre.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Mar��2 0( the year the�deduction is to 6e effective.
SON COUNTV qUDITOR
See reverse side for additional instructions and quali�cations.
Applicant
Taxing
contract buyer - see
Assessed value oi real property as of
March 1, current year
If no, whal is his / her exaa share of i.
on reverse
�
K�/number / iegal description cord number p
2(0, /8-D.r7'/00 _000, 08c1 '0�� Page number /,rn - y / �S
Ll'�S-�G�B' -
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? �es ❑ No
� 70o0a . � /
If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of appiicant, indicate below:
mortgagee or contraIX seller
Address ot mortgagee or conVad seller (number and street, city, state, ZIP
Name of assignee or
of
owner or holder of mortgage
(num6er and sbeet, city, state, ZIP
Does applicantown property in any other I If yes, what county? What Taxing Distrid?
counfy in Indiana?
Deduclion approved in the amount ot:
20 �� 20 ��
P ,D
Signalure
COUNTY AUDITOR
20 _�� 20 20
�
County Auditor
property in question:
a'l Property ❑ Mobile Hane (IC 61.
Has this deduction been requested on
property for wrrent year? 0 Yes 0 No
20
20
We certify under the penalty of perjury that the above and foregoing information is irue and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
(ull name)
applicant
Person authorized by duly executed Power o( Atlorney
or by IC 6-7.1-72-.07
Address of authorized person