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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION -.� n ship Year
���w� J State Form 43709 (RS I 4-03)
� PrescriDed Ey Departmem of Local Guvemment Finance J
INSTRUCTIONS: %%%``' File Mark
To be filed in person or by mail with the County Auditor of the county whera the property i�ated. �n`
Filing Dates: 1) Real Property: Dunng the 12 months 6efore May 11 of the year the deduc -ig'to-tJe�ec '�-`-'-L"
2) Mobile Homes assessed underlC 6-1.1-7: Between January 15 and Marc �2�d�t�ie���e�t{ieTdefl�vehonFrs to be eflective.
See 2verse side for additional instructions and qualifrcations.
Applicant (owner or
Ta�cing
Key number / legal description I Record number
�j�- D / �l OD / /eC�b Page number
V /� 'r ' i
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cunent year ownef? ❑ Yes ❑ No
If no, what is his / her exact share of interest?
If name on record is different than that
of mortgagee or contraIX seller
Address of moRgagee or contrad seller
If owned with someone other than spouse, indicate with whom.
1, indicate below:
and sbeet, city, st e, ZIP
Name ot assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, ciry, state, ZIP code)
Does applicant own property in a
county in Indiana?
w y�•••• �istrid?
Draw�.......... �
aQ p 3 � �9 � �y�j �"O`
Car� •• " '� —
Jh,oOU.Od ...,.,,�uK
Deduction approved in the amoum or.
20 ��
Signature
Is the property in queslion:
❑ Reai Property ❑ Mobife Home QC 61.
vrQ�i�.
/ �-
Has this dedudion been requested on
property for wrrent year? � Yes � No
20 Q,5 20 7' 20 �Z 20 �_ 20
� � �
County Auditor Dat
20
We certify under the penalty of perjury lhat the above and foregoing informalion is true and corred and that lhe applicants was / were
esident o( Indiana and owner of the aforementioned property on March 1, 20
(owners (ull
, Person authorized by duly executed Power
,� or by IC 6-1.1-12-.07
ident address o applicant � n Address o( authorized person
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