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Have you filed for any other deductions? If yes, what deductions? �=.
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Have you filed for any deductions in any other county?�O If yes, what county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19 -
Signature Authorized Representative (by executed Power of Attorney)
Address of Applicant Address of RepresentatiJe
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