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iai '� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i'�; FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
. .. «. ', Stale Form 43709 (R6 / 5-06) . . . . . , � O ,,%��/7
� Presai6ed by Department of Laal Gwemment Finance � � � /�.i
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INSTRUCTIONS: � FileM�
To be filed in person o� by mail with lhe County Auditor o/ the county where the property is located. OCj 1 5 LV "�
Filing Dates: i) Real Property: Du�ng the 12 months before ,lune I1 0l the year the deduction is to be effect�ve. �/��
2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the yea� the de�j�cGon�{m� elfective.
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See �everse side for additional instnrctions and qualifications. COUNTY AUD� ��R
n G�gSON
Applicant
buyer- see restridi� on rev�se side)
.-:.� �! G ,f�2
C4�
Assessed value of real property as of
March 1, curtent year
Key number / legal description
, .. .
3�- �d'%- Odo. i
MoAgage / Contrad indebtedn
March 1, wrrent year
. ' / 9.r1. ix
If no, whal is his / her exad share of interest? If owned
If name on record is different than thal of applicant, indicate below:
of mortgagee or contrad seller
Address of mortgagee �or conVact seller (number and street, city,
:� .
Name of assignee or other owner or holder of mortgage
naaress ot assignee (number antl
Does applicant own property in any
county in Indiana?
ueoucuon approvea m the amount of:
ZIP code)
ZIP
Record number �Ob �
Page number 0 � �
as of Is lhe applicant Ihe sole legal or equitable
ownef? ❑ Yes ❑ No
someone other lhan spouse, indicate with whom.
If yes, what counry? I What Taxing Distr
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� I �
Signature
COUNTY AUDITOR
20
County Auditor
�
s the property
❑ Reai Proper
�
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❑ Moble Hortre QC 61.1-�
� �. �...
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Dra�rer'� /
Cara�O. .
20
20
�We certify under the penalry of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�Signature (owners full name) Person authorized by duly executed Power of Attomey
`�1 �y or by IC 6-1.1-12-.07
,F�rfl resident address of pplicant Address of authorized persori
� 3�G,CiN/Odr �/.Jinl�.�? T�i r1�f,�/