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�a` ' 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i'�'� FOR DEDUCTION FROM ASSESSED VALUATION . 7o shi Year
'�,%'+ State Form 43709 (R6 / 5-06) . . . . , . .. ' 0 9
O �� Presaibed by Department of Local Govemment Finance a
JUL 1 8 2001
INSTRUCTIONS: File Mark
To be /iled in person or by mail with the County Auditor o( the county whe�e� fhe prope�ty is located. �l% �
Filing Dates: 1) Real Property: Dunng the 12 months belore June 17 of the year the deduction is to be ellec �v �
2) Mobile Homes assessed under IC 6-1.7J: Between January 15 and March 2 o/thel�l'h�0PJ1V1L'tlqpl{Dt�QiE eSective.
See reverse side /or additional instnictions and qualircations.
Applicant(o erorcontractbuyEr-
Y�
Tauing i S �a
0
Assessed value of real property as of
6larch 1, cunent year
If no, what is his / her exad share of i
If name on
on
Key nufn6€r / I al d s�iption Record number �QQ �
������ ���v � �O2 Page number , �j
'J`lo a
Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No -
aV V
If wned with someone other lhan spouse, indicate with whom.
than that of applicant, indicate below:
of mortgagee or contrad seller
Address of moAgagee or wntrad
and street, ciry, state, ZIP
Name oi assignee or olher owner or holder of mortgage
Address of assignee (num6erand street, city, sfate, ZIP code)
Does z^���rant own property in arry other If yes, what county?
counfy -
Dedi
2�
�
Signature
Dra�ti�cr NO. ��: /
.......
Card NO. �(P !�.
��•�,�)..�.
- ,
_ I 20 � � �„
'r
What Taxing District?
• ! 'OUNTY AUDITOR
: i � --
20 I 20
County Auditor
s the property in question:
❑ Real Property p Mobile Home QC 61.1-�
Has this dedudion been requested on
property for current yeaR� Yes❑ No
�
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March t, 20
nature (owners /ull name) _ Person authorized by duly executed Power of Attomey
�d1YU.t�.( �i I/ ,, , n� � o� by ic s-i.�-iz-.o�
Fuil resident"address of applicant � Address of authorized person
I I��.11 ll h�i 5.S� i�'i nCP-�h, /N u��1�