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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RS I 4-03)
PfesaiDeO Dy Departmant of Local Govemment Finance
INSTRUCTIONS:
'� � �1 �File Mark
To 6e �led in person or 6y mail with the County Auditor of the county whe2 the property is located. � �' �-� ""'
Filing Dates: 1 J Real Property: Dunng the 12 months belore May 17 0l the year the deduction is to be effective. ] n
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the 6ed�clW�is�a'b� eflective.
Year
See reverse side lor additional instructions and qualifrcations.
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Applicant (owner or contracf buyer - trictions on reverse side) ' ' """"' --
Taxing Distrid Key number / legal descri n Record number
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D/9�/o�a-�a Pagenumber
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicanl, indicate below: Is the property in question:
Real Property ❑ Mobile Home QC 6�1.1-�
�me of mortgagee or contred seller /
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Address of mortgagee or wntract seller (number and street, city, state, ZIP � `.
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and st2et, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
counfy in Indiana? property for current yea(? � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amounl of:
20�� 20 20� 20� 20 O� 20 20
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Signature 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
Signatur ners full na ) \ Person authorized by duty exewted Power of Attomey
or by IC 6-1.1-12-.07
F II resi nt address of appli Address of authorized person