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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
�� -✓ . SUte Fortn 43709 (RS I 4-03)
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P2scriCaE by Department of Loral Govemment Finance
Coun Township Year
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INSTRUCTIONS: Fi��} �
To be (led in person or by mail with the County Auditor o/ the county where the property is located. N �� � 3 L""'
Filing Dates: 1J Real Property: Dunng the 12 months belore May 11 0/ fhe year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ tAe year �e� �edu �tro�s to be ef(ective.
See reverse side for additional instructions and qualifications. � �
GIBSON COUNTY AUDITOR
6uyer- sqe restncjons on reverse
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Taxing Dislrid
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Assessed value of real property as of
March 1, wrrent year
If no, what is his ! her exact share of interest?
If name on record is differeni
of mortgagee or contrad seller
Address of mortgagee or.contract
number
Record number
Q/�i _ D� ���� Page number �
O�
MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
applicant, indicate below:
city,
Name of assignee or olher owner or holder of moAgage
Address of assignee (numberand sf2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the �
20 20
1
Signature
If owned with someone other than spouse, indicate with whom.
ZIP
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What Taxing _..
COUNTY AUDITOR
of:
20 0 20 20
P
County Auditor
Has this dedudion been requested on
property for current year? �] Yes � No
20
Date
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We certify under the penalty of perjury that the above and foregoing iniormation is true and corred and that the applicants was / were
�es�fent of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full�d�nt address of abplicanj� � �Address of authorized person