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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
' z+ «� J State Fortn 03709 (R5/4-03) �� �
Prescn0etl Oy Department of Local Govemment Finance
� �
INSTRUCTIONS: AUG 1 5 Z�,Q�Maric
To 6e filed in person or 6y mail with the County Auditor of fhe county where the property is located.
Filing Dates: 1) Real PropeRy: During fhe 12 months before May 11 of the year the deduction is to be?eflg�ve3�
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oI the year the deduction is to 6e effective.
See reverse side for additional instructions and qualifications.
GIBSQN COUNT" ;,""•-"':
ouyer
i�
xing Distrid
�O��r�
Assessed value of real property as of
March 1, wrrenl year
on
Key numb r/ legal descriplion
�tG�s�/9-/Os�-a�. -
oa3-oa6�y_ �
Mortgage / Contract indebtedness unF
March 1, current year
�o/a00
Ii no, whal is his / her exacr share of interest?
If name on record is different than that of applicant, indicate below:
Record number
., .
Page number � ^ � x
q� U
as of Is lhe applicant sole legal or equitable
owner? s ❑ No
If owned with someone other than spouse, indicate with whom.
�me of mortgagee or contract seller �j
�
Address of moAgagee or contrad seller (number and st2et, 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 other If yes, what county? What Taxing District?
county in Indiana?
�g� t � � �J. /� � ` n� COUNTY AUDITOR
Deduc1ion approved in the amount of(/ "
20 20 �� 20 �
P P e
Signature
20
County Auditor
20
property in question:
Property ❑ Mobile Home (IC Cr1.1
Has this dedudion been requested on
property for wrrent year?Q Yes❑ No
�
Date
20
We certify under the penalty of perjury that ihe above and foregoing information is true and corred and that the applicants was / were
resident o( Indiana and owner of the aforementioned property on March 1, 20
�II name)
5 �
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
Full resident aAdress of applicarx Q �Address o( authorized person