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.tt�na STATEMENT OF MORTGAGE OR CONTRACT
a�•' P Y
a�. � INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
' VALUATION State Form 43709 (1-90) Prescribed by the
'' �• ` State Board of Tax Commissioners
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the
property is located during the 12 months before May 11 of ihe year the deduction
is to be effective. See reverse for additionai instructions and qualifications.
Taxina District
Key Number/Legat Description
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Filin fee $1.00
County Township Year
. File Mark�
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Record No.
No.
Assessed valu@Jof real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of �c¢ ��u�n�ear. equitable owner? O yes O no
�
If no, what is his/her exact share or interest?
If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contract
Address c?f mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
of Assignee
Does applicant own !eal property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19�-�'� 19� 19�,bQ� ��;
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Signature
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ad3 � 19
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Secretary of Board of Review Date
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I/We certify un�er penalty of perjury that the above and foregoing information is true and correct and that the appli-
was/were a resident oi Indiana and owner of the aforementioned property on March 1, 19
� at owners full name Person authorized by duly executed Power of Attorney or
, � by IC 6-1.1-12-.07).
Full Resident Address of Aplicant Address of Authorized Person