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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�'. ��� ! Siate Fortn a3709 (RS / 4-03)
� P25cri�ed py Department ot Local Gtivemment Finance
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To be filed in person or 6y mail with the County Auditor o/ the county where the propeKy is located.
Filing Dates: 1) Real PropeRy: Dunng the 72 months be(ore May 11 0/ the year the deduction is to be e/fe `�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year th�'o�r�T�ee eflective.
See reverse side for additional instructions and qualifications. GIBSON COUNTY UOITOR
Applicant (owner or contract buye� - see trictions on revers ide)
Taxing Distrid �\ number / legal descri ti Record number �
O O � Q�� �p I' Page number �j �
N> "�
Assessed value of real property s of Mortgage / ontract indebtedness unpaid as of Is ihe applicant the sole legal or equitable
March 1, cunent year March 1, current year owneR ❑ Yes ❑ No
� l VU�/
If no, what is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
ie of mortgagee or contract seller .
Address of mortgagee or contract seller (number and street, city, s te, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current year? �] Yes � No
COUNTY AUDITOR
Deduction approved in lhe amouni of:
20 �� 20 _� 20 Q� 20 a0 20 20 20
� f �
Signalure County Auditor Date
e ceAi r the penalty of perjury that the above and foregoing information is lrue and corred and that lhe applicants was / were
..side of India a and owner o t aforementioned propeRy on March 1, 20
i a full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full r id t addre s of a plicant Address of authorized person