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;i ,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1i ; FOR DEDUCTION FROM ASSESSED VALUATION un s Year
`': ��� Siate form 43709 (R6 / 5-06)
Presrnbetl by Depanment of Local Govemmen� Finarice D E C 1 1 Z006
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INSTRUCTIONS: �%a---,F'�e �c
To be filed in person or by mail with the CountyAuditor of the county where the propeRy is Iocated.����nN COUNiY AUblfip�l
Filing Dates: 1J Real Property: During the 12 months befo�e June Il of the year the deduction is to ETCfive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year the deduc6'on is to be effective.
See reverse side foi additional instn�ctions and qualifications.
Applicant (owner or cont ct buyer - see restrictions on reverse side)
Taxing Distrid , Key number / legal desuiption Record number
G�a- Pao3-ooa. /�% �
��/�� 0/¢ b a o��� � v� Page number / /�/
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legat or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horne (IC Cr1.1-�
me of moAgagee or contrad seller .
Address of mortgagee or contract seller (number and street, city, state, ZIP •
Name of assignee or other owner or holder of mortgage / -
Drawer NO.G�:�Cl?.,.,,.
Address of assignee (number and sheet, city, state, ZIP code) /1 � I/ /
, .
Ca►•ci NO. .:.
/ ��.....a...... ...
Does applicant own property in any other If yes, what county? What Taxi . �(1X„p, �. �j I on
county in Indiana? � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 �_ 20 � 20 20 20 20
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Signature County Auditor Date
/ We certify under the penalty of perjury thal lhe above and foregoing information is true and corred and ihat the appiicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signalure (owners (ull name) Person authorized by duty executed Power of Attomey
� � ���_" or by IC 6-1.1-12-.07
� Full resident address of applicant Address of authorized person
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