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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Suta Fwm 43709 (RS l 4-03)
PrescriDed Oy Department ot Laat Govemment Finance
INSTRUCTIONS:
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Coun Township Year
To be filed in person or by mail with the County Auditor of the county where the property is located. ���Ie� �
Filing Dates: 1) Real Property: During the 12 months belore May 11 0( the year the deduction is to be eflective.
2) Mo6ile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 of the year th�e��/uftipn isJ,o,be effective.
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See reverse side 1or additional instructions and qualifications.
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Applicant (owner or cont cf buyer - see restri ns on reverse side) �BSON COUN7Y AUDITOR
Taxing Distrid Key ber / legal description Record number �
q>' �`O OD c O,�\ Page number
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Assessed va oi real property as of Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sol legal or equitabie
March 1, current year March 1, current year owne(? ❑ 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 different than that of applicant, indicate below: Is the property in question:
� � Real Property ❑ Mobife Home QC 61.1-�
�me of mortgagee contrad seller
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Address of mortgagee or contract seller (number and stre t, city, s te,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested 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 County Auditor Date
�/ We certiy under lhe penalry of pequry thai the above and foregoing infortnation is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned properfy on March t, 20
S' nalu wners /ull name) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
Full reside t address of ap icant Address oi authorized person