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/� 3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
° s FOR DEDUCTION FROM ASSESSED VALUATION
'v_w� ? 3tate Fortn 43709 (R6 / 6-06)
� I Presaibed by DepaNnent of Loml Govemment Finarxe
INSTRUCTIONS:
Count Township Year
, � � �
OCT 2 7 2006
File Mark
To 6e filed in pe�son or by mail with the County Audito� of the county whe�e the propeRy is located.
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune 17 0l the year the deduction is to be e� cfive.���
2) Mo6iie Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of t�e �ea��the�deduc6'on�'s�;¢e effective.
See reverse side for additional insfnictions and qualificafions.
Applicant (owner or confracf buye� see restricfions on reverse side)
f� emmlQ
Taxing Distrid Key number / legal description Record number
G-i� �a-aoa-�. oa� oaa aa� �
Page number
9JU2rn.ox„Q� O 1�l - b000 �- oa `/ 5' �t
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, currenl year owneR [�4'es ❑ No
� �
If no, what is his / her exad share of interest? If owned with someone olher lhan spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below: is� t�he property in question:
C7"Real Properly ❑ Mobile Home QC 61.1-�
me oi mortgagee or contract seiler
Address of mortgagee or contrad seller (n ber and street, city, state, ZIP
Name of assignee or other owner or holder of moRgage
Address of assignee (number and st2e1, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this dedudion been requesled on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �Z 20 � jL 20 O� 20 20 20 20
p
Signature County Auditor Date
We under the penalty of perjury that the above and foregoing infortnalion is true and corred and that the applicants was / were
resid nt f Indiana and o r of th oremenlioned property on March 1, 20
Signat e( wners full na ) Person authorized by duly executed Power of Attorney
x or by IC 6-1.1-12-.07
Full r si ent a dress of applicant Address of authorized person
Y