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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form a3709 (R5l a-03�
Prescribed by Departmem of Local Govemment Finance
Coun Township Year
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INSTRUCTIONS: DEC File M�3
To 6e filed in person or by mail with the County Auditor of the county wheie the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 01 the year fhe deduction is to be eBective. f %7, ;. ��
2J Mobile Homes assessed underlC 6-1.1-7: Between January 15 and March 2 ot thery`eactAe deduction is tobe!e8ective.
See reverse side foraddiUonal instructions and qualifications. U ��p�'�`'� r�' -'���.�0`' '
Applicant (o er or contr@c 6uyer - s iestrictions rev ide)
Taxing ct Key number / legal description Record number
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Assessed value o real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant e sole legal or equitable
March 1, curtent year March t, current year ��� Ig(e9 owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
. If name on record is diHerent than that of applicant, indicate below: Is the property in question:
❑ Real Properry ❑ Mobile Home (IC E1.1-7)
�e of mortgagee or contract seller �
Address of mortgagee or contract seller (number and street, city, stat , ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP code)
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Does applicant own property in any other If yes, what counry? What Taxing District? Has this deduction been requesied on
county in Indiana? property for current year? ❑ Yes ❑ No
, COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 � 20 � 20 �� 20 � 20
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Signature Counry Auditor Date
"�We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
S�ature (ownels full name) Person authorized by duly executed Power of Attorney�
or by IC 6-1.1-12-.07
F I res' t addre of applicant T�1 Address of authorized pereon
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