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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court non
l FOR DEDUCTION FROM ASSESSED VALUATION
state Form 03De 6-09) FEB 12 4014
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Pnesaibed by Department of Local Government Finance
File Mark
INSTRUCTIONS: F. _e ri
To be filed in person or b mail with the Court Auditor or County Recorder of the county where the is located. L"f j l' ����'
by d b ty �� ITOR
Fling Dates: i) Real Property Must file during the year for which the deduction is sought GIBS 4 CetOr ingp
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 - ❑ County Recorder
See reverse side for additional instructions and qualifications.
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Key / d tnn Record number Pagers
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Conan indebtedness unpaid as of ' Is the ap t the sole
March I.anent year Marc t,current year data of appficodon /17) legal or equitable owner?
(/L/^ !�S/�Y ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone over than spouse,Indicate with whom
If name on record is afferent than that of applicant,indicate below. Is property in question:Annually Assessed
Real Property ❑Annually Assessed
_�� Mobile Home QC 61.,-7)
Name of mortgagee or contract seller L�
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
-
Address of assignee(number and sheet,city state,and ZIP code)
Does applicant own property in any other If yes,what county? - 1 What Taring District? Has this deduction been requested on property
tarry in Indiana? for Yes ❑ No for aarent year? ❑ Yes ❑ No
COUNTY AL -
Deduction approved In the amount at. /
20 20 zo 20 DrawerNO•• (3 ro
Signature of County Auditor - h Card NO .. qL
I/We certify under the penalty of perjury that the above and foregoing inform ... Indiana and
owne /contract buyer of the afo�reme ed property op date application is Meru.
�'— 1 '��������`�'/ // Date( Y.)'ear)
Full resident address of t(number and street afy,state,and ZIP code)
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Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and=met,city,state,and ZIP code) .