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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fortn 43709 (R6 / 5�06)
Prescnbetl by Department of Loral Govemment Finance
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INSTRUCTIONS: File ark
To be filed in person or 6y mail with the County Auditor ot the county where lhe p�operty is located. A�� ] 2���
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune I1 of the year the deduction is to be eHective.
2) Mobile Homes assessed under lC 6-7.1-7: Between January 15 and March 2 o/the year-6te ded�s to be eflective.
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See reverse side /or additional instrucfions and qualifrcations. G�gSON COUNTY AUDITOR
Applicant (owner or contract u r- see restrictions on rev rse si �
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Taxing Distrid Key number / legal descriplion Record number ��
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Assess value of real property as oi Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitabte
March 1, cunent year March 1, current year owneR ' � Yes ❑ No '
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H 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 lhat of applicanl, indicate below: Is the property in question:
O Real Property ❑ Mohile Hane (IC Cr1.1-�
�e oi moAgage or contrad seller
Address of mortgagee or contrad seller (number and st2et; city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code) ' ' �
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
counfy in Indiana? property for curtent year? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount ot:
20 �� 20 �� 20 20 20 20 20
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Signature County Audilor Date
�� We certify under the penalty of perjury that the above and foregoing information is true and corred and thal the applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
1. 1 � 1 or by IC 6-1.1-12-.07
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Full resident address of applicant Address of authorized person
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