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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
'`. «. ! Siate Fortn a3709 (RS / 4-03) _ _. � .
� Prescribed by Department ol Local Govemment Finance � (�+J ��{' • r'' I� ,/
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INSTRUCTIONS: `�File Marli 2003
To be filed in person or by mail with the County Auditor of the county where the propeKy is located.
Filing Dates: 1J Real Property.� Dunng the 12 months before May 11 0l the year the deduction is to be effec ivt e. � � ��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year Nie deduction is fo 6e`effectiv_e:
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See reverse side for additional insfructions and qual�cations.
Applicant
DistriIX
orcontract 6uyer- see restrictions on reverse
Assessed value of real property as of
March 1, wrrenl year
no, what is his / her exact share of interest?
Key number / legal description 1 I Rewrd number
� 1 - . Page number
� O ._ �
Mortgage / Contrad indebtedness unpaid as of Is the applican the sole legal or e
March 1, current year owne(? es ❑ No
l� 1 � C]
If owned with someone other than spouse, indicate with whom.
I( name on record is diNerent than ihat of applicant,
of mortgagee or contrad seller
t mortgagee or conlrad se .
and sl2et, c�, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP
Does applicant own property in any olher If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20
Signature
200�
�
❑ Mobite Home (IC 61.
What Taxing /� �^ �pQo � o�
Drawer NO...��..........� 7 7No
' ' Card NO.
.....................
COUNTY AUDITOR
20 �� 20 �Z 20 �_ 20 �� 20 _
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County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�nal�y�g (owners /ull name) Person authorized by duly exewted Power of Attomey
�Il
) �{,C �.. .. �Q %i,� . T, . , or by IC 6-1.1-12-.07
sident address of applicant Address of authorized person
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