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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'' ; FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�' . -y State Fwm 43709 (R6 / SO6) , ^_ _ r _ '..—� -�—e �
Presaibetl by Department of Local Gwemment Finance �--� '!
� � .. i �� / !�
INSTRUCTIONS: ��j F�Ie:Maiic�s
To 6e filed in person o� by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real P�operty: During the 12 months 6efore ,lune I f ol the year fhe deduction is to be eBective. ��,
2) Mobile Homes assessed unde� IC 6-1J-7: Between January 15 and Ma�ch 2 o/the year the,deiiuc6on is t�be effective.
See reverse srde /or additional instroctions and qualifications. r•� c p; :;, �� �;aT'1 AUDI70R
or contract
Taxing Dist'
���1.��
Assessed value of real property as of
March t, curtent year
restrictions on
no, what is his / her exad share of interest?
If name on record is diBerent than that of
of mortgagee or contract seller
Key nu er / legal description
24-I -O7-3o3-ooU.�s
Dl�-ODdas-oa
Mortgage / Contred indebtedness u
March 7, current year
.�3Soa
Address of moAgagee or contrad seller (number and st2et, city, state, ZIP
of assignee or other owner or holder of mortgage
of assignee (number and st2et, city, state, ZIP
as
number
Page number
� •
, ..
Is the applicant the sole legal or equitable
owneft ❑ Yes ❑ No
with someone other lhan spouse, indicate with whom.
Dces applicant own property in arry other If yes, what counry? What Taxing Distrid?
county in Indiana?
,
Dra���er NO...�::`.i(�.......
Card N0. ....��.,��', �.......
-� 33, Sco
COUNTY AUDITOR
_ 2o zo
' County Auditor
s the property in question:
❑ Real Pnoperty ❑ Mobile Hm�e (IC 61.1-�
Has this dedudion been requested on
property for wrrent yeaR � Yes� No
zo
Date
�
We certify under the penalty of perjury thal lhe above and foregoing information is true and corred and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
esitlent a00r�s ot appucanl p Address of authorized person
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