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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
c,-..,,t State Form 43709(R11/6-09)
` Presaibed by Department of Local Government Finance it
INSTRUCTIONS:
o�nN with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is IocaR 2.,
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought. wt • -ty Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or con -buyer-see v reverse sitle C1060N COUNTY AUDITOR
Taxing District / .Key number legal desaiption� �� Reco number Page number
Vv • ii. �i7 -/ R - 96 / axsa796RR 050/ 3 c5'0/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the
Mach 1,anent year March 1,current year date of application legal or equitable owner?
t -3 0 Yes ❑ No
0 no,what Is his/her exact-• -`
— :_.___..,. _ __ __ -_ i If nun.,'with someone other than spouse,indicate with whom
If name on record is ddferer Is the m
P PertY in question:AnnualtyASSessed
ff) //l1 �l ❑Real Property ❑Mobile Annually Assessed
c.1 Q�i,C , Mobile Home(IC 61.1-T)
Name of mortgagee or coot �/ /1 efo U�! v
Address of mortgagee or a (_ /�-� I I
Name of assignee or other 1h,
Address of assignee(nacre 1 ,01a _ I SO 1
Does applicant own proper. _ ng District? Has this deduction been requested on property
county in Indiana? for current n
v\ _ ❑ Yes El No
�Q ( VQ
0. t
Deduction approved in the £01 LO- �
W�/`�� .
20 ,,0 20 20 20
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Signature of County Audits �� /1/ /1 Date(month,day,year)
I/We certify under U ^' f`2-'�-+ , rue and correct and that the applicant is a resident of Indiana and
owner I contract buy(
(owner's tuft nan Date(month,day,year)
•
OCda fti)suz? N '1766Z
•
erson authorized by duly Date(month,day,year)
Address of authorized pen \w v`,\\
1