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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the MAY 0 6 199�
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. �(
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Applicant (Own
.
Key Number/Legal Description
No.
V.J •� JV�-��'� T Q � Page No.
Assessed value of real property as, Mortgage/Contraci Indebtedness unpaid_ Is the applicant the sole legal or
of March 1, current year as of March , u�,renQt y�ar� equitable owner? O yes � 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 of mortgagee or contract
er
or other owner or holder of Mortgage.
Address of Assignee
Does applicant own real property I If yes, what county? I What Taxing District? I 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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Sign �u`e
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Secretary of Board of Review
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Date
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I/We certify und�r penaity of perjury that the above and foregoing information is true and correct and that the appli-
nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
ignature (owners full name) Person authorized by duly executed Power of Attorney or
�-nn_ t�.) l�_ _/1f 0 by IC 6-t.1-12-.07)-
Resident Addr�ss o�Aplicant � Address of Authorized Person