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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R5 / 4-03)
PrescnDeO by Depertment o( Loral Govemment Finance
�TRUCTIONS:
be filed in person or by mail with the County Auditor of the county where the property is located.� [UU�
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ tAe year the deduction is to be,effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year fhe deduction is to be eHective.
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See reverse side (or additional instructions and qualifications. � � �
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Applica owner or contract 6uyer - see r sMctions on 2verse slde)
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Taxing Di trict Key number / legal description Record number /_ Q�
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0/ 9-�� 90 9-� Page number
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? d`Fe�� 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 that of applicant, indicate below: Is th�e pr�operty in question:
�Fi�fa Property ❑ Mobile Hane (IC E1.1-7)
Name of mortgagee or contract seller
ress ot mortgagee or contrect seiler (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Addressofassignee(numberandstreet,ciry,state, �� � �+ _ee�
Name Cyn�iQ Fj� ��
Does applicant own property in any oiher If yes, wb �OCUITIept ^/_ C%� �7 d on
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county in Indiana? DBie �� -� ❑ No
Bankh%,-w�flcJc(�5 �a-r`da
/ COUNTY AUDITOR
De uction approved in the amouni of:
20 � 20 �,� 20 � 20 20 �� 20 � 20
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Signature Counry Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corzect and that the applicants was I were
a resident of Indiana and owner of the aforementioned property on March 1, 20
' nature (owners full n ) Person authorized by duly executed Power of Attomey
'' or by IC 6-1.1-12-.07
ull y dent address of applicant Address of authorized person
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