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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM A SESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
Instructions for filing: �i�"•
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 the year the deduction �
is to be effective. See reverse for additional instructions and qualifications��
Applicant
Taxing District
er or contract buyer - ee restrictions on reverse)
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Key Numb / I�escp�tion
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No. /���v /
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the ole legal or
of March 1, current year as of March 1, current year. equitable owner?�yes O no
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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:
�f mortgagee or con act seller
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Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
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Does applicant own real 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:
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Signature
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of�oard of Review
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��^.".'� certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
� waslwere a resident of Indiana and owner of the aforementioned property on March 1, 19 .
r'w ture (owngts full name) Person authorized by duly executed Power of Attorney or
II ��{ �. �--ll � by IC 6-1.1-12-.07).
Aplicant � Address of Authorized Person