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�ai � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i;�� FOR DEDUCTION FROM ASSESSED VALUATION Township vear
� ,«. / State Fortn 43709 (R6 / 5-06) �
Presaibed by DepeNnent of Loml Gwemment Finarxe
JAN 0 5 2007
INSTRUCTlONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.�
Filing Dates: 1) Real Property: Du�ng the 12 months befo2 June 71 0! the yea� lhe deducfion is td'be L��
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March �1B37B,yg���e ���R to be efiective.
See reverse side lor additional insfn�ctions and qual�cations.
Applicary,(ownerorcon�t buyer- see restricti ns on reverse side)
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Taxing Distrid Key number / legal description Record number
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��j� O� 7—Q� S�/ "�J Page number
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Assessed value of real property as of MoAgage / Conlrad indebtedness unpaid as of Is the applica t the sole legal or equitabie
MarcFi 1, current year March 1, currenl year ownef? �es ❑ No
/
700
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is difterent than that of appiiwnt, indicate below: Is the property in question:
ea� Propaty ❑ Mobile Home (IC 61.1-�
me of mortgagee or contract seller � � /
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Address of mortgagee or contrad seller (number and st2et, city, stafe, ZIP ry��,3
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Name of assignee or other owner or holder of mortgage O
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Address of assignee (num6erand street, city, state, ZIP code) �C��� _. ••' �°
a�o• '��
Does applicant own property in any other If yes, what county? What Taxing r,3C M Q� •.edudion been requested on
county in Indiana? ,¢ /.�� ��..Nerty for wRent yeaf?O Yes❑ No
d d COUNTY AUDITOR
Dedudion approved in fhe amount f:
20 6� 20�_ 20 � 20 20 20 20
4 �
Signature County Auditor Date
�/ We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
a resident of Indiana and owner of lhe aforementioned property on March 1, 20
Signatu owner full na Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
Full res ent a ess of applicant Address of authorized person
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