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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 03709 (RS / 4-03)
PrestriDeO Dy Department oF Local Govemment Financa
Coun Township Year
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INSTRUCTIONS: i a�
To be �led in person or by mail with the Counry Auditor o/ the county where the property is located. MAR t �t ���
Filing Dates: 1J Real Property: Dunng the 12 months before May 11 o/the year the deduction is be eHective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ e year the deduc�on is to�be ffective.
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See reverse side for additional instructions and qualifications. �c r.� r �.��7T :• r ��^• �^•
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Applicant (owne r contract buye� - see restrictions o verse side) '
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Taxing District Key number / legal description Record number
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O / �_ Q � _ �h Page number �� �_
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Assessed value oi real property as of MoAgage / Contrad indebtedness unpaid as of is the applipnt the� ole legal or equitable
March 7, current year March 1, current year owner? , Q"Yes ❑ No
3 g�d
It no, what is his / her exad share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below: Is lhe,�roperty in question:
Q'Real Pmpert�r ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contrad seller
Address of mortgagee or contrad seller (number and sf2et, city, state, ZIP '
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? property for wnent yea(?� Yes� No
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COUNTY AUDITOR
Deduction approved in the amount of:
20 �� zo Q_ zo QZ zo � zo 0 9 2o zo
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Signalure County Auditor Date
� We certify under the penalty of perjury that the above and foregoing informalion is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur (owners full name) Person authorized by duly executed Power of Attorney
rY �' or by IC 6-1.1-12-.07
Full sident address of applicant Address of aulhorized person