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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION � Coun Township Year
S ! State Fortn 43709 (RS / a-03) � _ . � .
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PresaiDed Ey Depanment of Loral Gtivemment Finance �
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INSTRUCTIONS: \� � n � � �y�
To be filed in person or by mail with the Counry Audiror of the county where the property is locate� ��. �,,
Frling Dates: 1) Real Property: During the 12 months before May 11 0/ the yea� the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 o/the yea[-the deduc�io��s to 6e eNective.
See reverse side (or additional instructions and quali�cations.
(owner
District
see re$mction; on reverse
Key number / legal
Record number
��Gi^ �oj� O�0 .. Q� 7 (f'U� Page number / / �
t.�.I GICr{.I
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of I Is the applicant the sole legal or equitable
March 1, wrrent year ' March 1, current ye2.r owneR ❑ Yes ❑ No
Ii no, what is his / her exact share of interest?
If name on record is different fhan that of
of mortgagee or contract seller
7� I
If owned with someone other than spouse, indicate with whom.
indicate below:
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Address of mortgagee or conirad seller (number and street, city, state. ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, city: stale, ZIP code)
Does applicant own property in any other I If y�s, vfiat county % I 1�•lhat Taxing District?
county in Indiana? ! ,
Deduction approved in the amount ot:
20
Signature
20
COUNTY AUDITOR
2� 2� _tf+i— 2� Q
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County Auditor
Isthe propertyin question:
❑ Real Property O Mobile Home (IC 61.
Has this deduction been requested on
property for wrrent yeaR � Yes ❑ No
zo
Date
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' We certify under the penalty of perjury that the ahove and foregomg information is true and correct and that the applicants was / were
resident of Indiana and owner of ihe aforemer.;ioned property on March �, 20
Full resident afSBreSs of
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Address of authorized person