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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (R4! 10-01)
PrescriDeO by Depanment ot Laal Govemment Finance
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INSTRUCTIONS: File Mark
To 6e filed in person or by mail with the County Auditor of the county where the property is focated. F E B � 3 2QQ3
Filing Dates: 1) Real Pioperty: Dunng the 12 months before May 11 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC Ef.l-7: Befween January 15 and March 31 of the year the ded tion s to be eNe 've.
See reverse srde for additional instructions and qualifrcations. - GIBSON COUNT y q��pITOR
Appli nt ( wnerorcontract buyer- see re 'ctions on rev rse side)
Taxing Distrid Key number! legal description Rewrd number
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� Page number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the s e legal or equitable
March 1, current year March 1, current year ownef? es ❑ No
3�OOd .
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 diBerent than that of appiicant, indicate below: Is the property in question:
❑ Real Property � Mobile Home (IC 6�1.1-�
�ame of mortgagee or conVact sellel
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Address of mortgagee or contrad seller (nu r and street, city, sfate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appliqnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curcent yeaR � Yes ❑ No
COUNTY AUDITOR
, Deduction approved in the amount of:
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Signature County Auditor Date
1/ We certify under the penally of perjury that the above and toregoing infortnation is true and correct and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Signalure (owners /ull name) Person authorized by duly executed Power of Attorney
� r� or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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