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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (R4 / 10-01)
PrescribeA by DepaMrenl W Local Govemment Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor o/ the county whe2 the property is located. (� E � j'] 2QQ2
Filing Dafes: 1) Real Property: During the 12 months befo2 May 11 0l the year the deduction is to 6e e%fect�ve.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ t e year the d due�� n is to be ective.
See 2verse side for additional instnic6ons and qualifica6ons.
` 618SONCODUTV AU�ITOR
Applicant (ownerorcont2ct buyer- see 2sMctions on reverse side)
Taxing Distrid Ke n m er / legal description Record number
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Page number
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Assessed value of real property as of MoAgage / Contred indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March 1, wrtent year March 1, curtent year owneR Q�(es ❑ No
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If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below: Is the property in question:
Real Properly ❑ Mobile Hortie pC 61.1-�
me of mortgagee ar contrad seller
A dress of mortgagee or contract selier (number and st2et, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Dces appliqnt own property in any other If yes, what county? What Taxing District? . Has this dedudion been requested on
county. in Indiana? property for curtent yeart � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 Q� 20 20 20 20 20 �� 20 ��
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Signature County Auditor Date
' We certify under the penalty of perjury that the above and foregoing information is true and corred and that fhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners /ull name) ` Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
,Fu I resident a ess of applicant Address of aulhorized person
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