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� i � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'�a' �= FOR DEDUCTION FROM ASSESSED VALUATION
�+ State Fwm a3709 (R6l 5-OG) ' ' � �
� Presaibed by Department of Local Gwemment Finance
INSTRUCTIONS:
To be filed in person o� by mail wdh the CountyAuditor of the county where the property is located. f1fT 2007
Fi/ing Dates: 1) Real PropeRy: Dunng fhe 12 months 6efo2 ,lune !1 0/ the year the deduclion is to be EffeCti�.
2) Mo6ile Homes assessed unde� IC �6-7. 7-7: Between January 15 and Ma�ch 2 of the yea�r- yth�e, deduction is to be effective.
See reverse srde foradditional instructions and qualifications. o'`°'�'6�
GIBSON COUNTY AUDITOR
see 2stctcuons on
Taxing
Assessed value ot real property as of
March 1, current year
Key
MoAgage / Contract ii
March 1, t year
�%D,C
Record number � �
T/y') 7�h enumber / ���
�vw /Oy �Q
ness unpaid as of Is the applicant the sole legal or equilable
owne(? ❑ Yes 0 No
/ �
If no, what is his / her exad share of interest? / If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Hortie QC 61.1-�
�me of mortgagee a conUact seller
(��r,
Address of mortgagee or conVad seller (number and st�eet, city, state, ZIP
Name of assignee a other owner or holder of mortgage
of assignee (num6er and sheet, city, state, ZIP
Does applipM own property in any other If yes, what camN? I What Taxing Distrid? Has this dedudion been requested on
county in Indiana? — property for wrtent yea(? � Yes � No
Dra���er NO. �,�,a,:.���5—
Dedudion approved in the amount of:
20 � zo 0 9 2o i
� � I/
Signature
�ard NO. ....
� ���.. .. . ...... —
U°-�-
/a, o�. �o
� 20 � -- - -
County Auditor
Date
zo
We ceAify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ot applipnl �Address of authorized person