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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION CouMMn Township Year
�'• w� / State Form a3709 (RS / 4-03) �
� Presaihed Ey Departmeni ot Loral Govemment Finance
�NSrRUCnoNS: MAR 0 7 2001
File Mark
To be filed in person or 6y mail witA the County Auditor of fhe county where the propeRy is located.
Filing Dates: 1) Real Pioperty: During the 12 months before May 11 of the year the deduction is to be eB o}i� ��
2J Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ the /h a de�/�����o� to he effective.
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See reverse side for additional instructions and qualifications.
Applicant (owne� or contract buyer - see restrictions on reverse side)
Taxing Distrid � � �� �Key number / lega�
Record number
� � �_ py _a��� _ �,^^ ' - ae n� ber
1J(Jll
Assessed value of real property as of Mongage / ConlraG indebtedness unpaid as of Is the applicant t e sole legal or equitable
March 1, wrcenl year March 1, current year ownef? es ❑ No
d�
Ii no, what is his / her exaa share of interest? If owned with someone other fhan spouse, indicate with whom.
If name on record is diHerent than that of appiicant, indicate below: I� e property in question:
. . . �
mortgagee or contraIX seller
of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or
Address
owner or holder of morigage
(numberand st2et, city, state, ZIP code)
�'
�!j
Real Properry ❑ Mobile Home (IC 61.
Does appiicant own property in any other If yes, what county? W„�, --��
county in Indiana?
, Ur�,��,. _ .�►7... ..
COUNTYAUDITOR �ard iy�, ,. 1 I.�// _
l l 7 l..P
Deduclion approved in the amount of: �,/ � 5/�' �O �/ "'
��- � �i�� � � �_��
1 I �
Signature
l�
County Auditor
20
Date
20
We certi(y under the penalty of perjury lhat the above and foregoing information is true and corred and that lhe applicants was / were
�esidenf of Indiana and owner of the aforementioned property on March 1, 20
(owners full
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ress of applicant �Address of authodzed person
�n
No