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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEONESS
FOR DEDUCTION FROM ASSESSED VALUATION
� �� / State Fortn 43709 (R5 / 4O3)
� PresaiEetl Dy DepartmeM of Loral Govemment Finance
Coun Township Year
�' � 1_� :� ��
INSTRUCTIONS: FEB 1F�le+�
To be filed in person or by mail with the County Auditor of the county where the property is located� i�
Filing Dates: 1J Real Property: Dunng the 12 mon[hs 6efore May 11 oI the year the deduction is (o be eBectiv� i1 y�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/tAe y�earthe`deductiomrsto be eHective.
�' GIBSOta COU;J7r tiuDiTOR 1
See reverse side for additional instructions and qual�cations.
a�-l3 �3.5=.� oG oo ►.��� g-�Q r„
or contract buv�- see
Taxing
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Key number / legal description � Record number
U � ,(Y� � _ ���` �_ � Page number v �
lSC<•
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole egal or equitable
March 1, wrrent year March 1, curr � t year �r mn ownef? ❑ Yes � No
(JUV
If no, what is his / her exact share of interest?
name on record is differenl than thaf of applicant,
of moRgagee or contrect seller �/�
below:
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrad seller (nuraSber and slreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any olher I If yes, what county? I What
counry in Indiana?
Deduction approved in the amount of:
20
Signature
20
s the property in question:
❑ Real Properly ❑ Mobile Home pC 61.
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Drawer NO•�•�.".'�...... `}
........
CardNO..••••••••""'
COUNTY AUDITOR
20 _� 20 �_ 20 � �
P P ..P
County Auditor
_quested on
N�operty for current yeaR � YesO No
20
Date
±3�]
We certify under the penalty of perjury that the above and foregoing information is lrue and corred and that the applicanls was l were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by
or by IC 6-1.1-12-.07
Full res�elft�address of appliqnt — " �Address of authorized person
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