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�o,E�re4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e . FOR DEDUCTION FROM ASSESSED VALUATION
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1' ., State Form 43709(R14/1-20) 2
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5;8 Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by maiL
Form
filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. pC1 County Auditor
Must be flied or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
App' ant(owner or contract buyer-see restrictions on reverse side)
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Assessed value f r I property a of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date, Trent year assessment date,current year date of application legal or equitable owner?
// g, COD Elves ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whoth
If name on record is different than that of applicant,indicate below: I t property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
NarrA.6f mortgagee o contract se lei
Address of mortgagee or contract seller(numberand street,city,state,and ZIP code) i l .--,
Name of assignee or oth -_ SEP 2 2020
Address of assignee(nu,
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Drawer NO ; y
Does applicant own prop � Has this deductio ' AU'
t T 9f2te amount of deduction
other county on ro '.',�
in Indiana? ❑YesS 81Scurrent
OW Yes ❑No
A person is not entitled person's mortgage or contract indebtedness that is recorded in the county
recorder's office(ihcluc C`rl I �' bounty recorder's office)that is the basis for the deduction.
• 4UDITOR .
Deduction approved in th,
20 20 20 20 20 20 20
Sipa firr of aunty Auditor County,Q4 Date(month,day,year)
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e certify under he p nalty of perjury th,iii- -bove and foregoing information is true and correct and that the applicant is a resident of Indiana and
ner/contract buyer of the aforementioafroperty on date application is filed.
Signature(owner's f me) Date onth day,year)
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Full resident address of ap leant(num Brand t,city,state,and ZlRcode)
9 gi, "X/ 5-25 4.5, d y 7Cap S
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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