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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 63709 (RS / 4-03) .
PresaiEed by Department ot Local Govemment Finarwe
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Coun Township Year
3
� TRUCTIONS: \� File Mark
To be filed in person or by mail with the CourityAuditor of the county where the properry is located.
Filing Dates: 1J Real Property: During the 12 months be%re May 11 0/ the year the deduction is to 6e effective.
2J Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side for additional inshuctions and qualifications.
Applicant (owne� or contracf buyer- e restridions on �everse side) .
Taxing Dislrid y number / legal description Record number
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Page number
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Assessed value of real properly as of MoAgage / Contract indebtedness unpaid as of Is the applicant th sole legal or equitabie
March 1, current year March 1, current year owneR �Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicanl, indicate below: Is the property in question:
�Real Pmperty ❑ Mobile Home (IC 61.1-�
�Name of moRgagee or contrad seller �
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
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Address of assignee (num6er and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? ` property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in fhe amount of:
20 20 20 ��L 20 � 20 �' 20 � 20
. � / �
ignalure County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20 �
ignature (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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