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,ai '� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`\i : FOR DEDUCTION FROM ASSESSED VALUATION Coun T Year
\• � .-w� / Slate Form 43709 (R6 / SO6) .
� Presaibed by Department of Lonl Govemment Finance �
pE� 4 2007
INSTRUCTIONS: File Mar1c
To be /iled in person or by mail with the County Auditor of the county where the property is located. . —y�l ��
Filing Dates: 1) Real Property: During the 12 months be%re ,lune 17 of the �ear the deduch'on is to be e((ectfJe�
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 of the�y�[��d�'gnA�IFd�ltective.
See reverse side lo� additional instructlons and qualifications.
or contract
Taxing
Assessed value of real property as of
March 1, current year
restrictions qq reverse
If no, what is his / her exact share of interest?
��-ia-o7 30,
MoAgage / Contrad ind�
March 1, cunent year
� `fSOO 0 '
tion ' Record number • -
�� 3/0_� Pagenumber
edness unpaid as of Is lhe applicant the sole legal or
ownef? ❑ Yes ❑ No
If awned with someone'other lhan spouse, indicate with whom.
If name on record is difrerent than that of applicanl, indicate below:
e oi mortgagee or conVact se r
' ��1.(/i Pii, i i _� ; �.
Addres6 of mortgagee or contrad seller umber ai �'`•�stafe, ZIP
�
Is lhe property in question:
Real Property ❑ Moble Home QC 61.1
Name of assignee or other owner or holder of m Dra <<.
er l�,O
Addresa of assignee (number and st2et, city Cal�QII`rO '"!C(�; � 1 �
•�6
Dces applipnt own property in any other If yes, what �°-��C �� . � Has this dedudion been requested on
county in Indiana? '� .� '' •., property for wnent year? � Yes� No
us�o�
Deduction approved in the amount of:
20 �� 20 � 20
P
Signature
COUNTY AUDITOR
�
County Auditor
20
�
Date
20
� We ceAity 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
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of applicafll IAddress of authonzed person