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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�a w� / State Fortn 43709 (RS / 4-03)
� Presvibed by Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of fhe counry wheie the property is located.
Filing Dates: 1j Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to b�'�ctQi e� 2U��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side ror additional instructions and qualifications.
1 � ' GIBSON COU ?•; cU�
Applicant
Taxing
Assessed value of real
March t, wrrenl year
buyer-see
of
If no, what is his / her exact share of interest?
on reverse
Rey number / legal description ecord number O�
/l/1/ _ Q�� (� _ U� Page number ��
6itl(O 7 �
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
D Q60
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant,
of mortgagee or contrad seller
below:
of mortgagee or contrect selier (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
of assignee (number and street, city, sfate, ZIP code)
s lhe property in question:
❑ Real Pmperty ❑ Mobile Home (IC 6�1.1-�
Does applicant own property in any other If yes, what county? I What Taxing District? I Has this deduclion been requested on
county in Indiana? n.�.,An�.f�� ���rrent year? � YesO No
DrawerNO ................ .
�o� Q3- 9`��
Deduction approved in the amounl of: CaC�] j�j�. ......... �<. /.....
20 � 20 0�� 20 � 20 _��
���t�d% � V �
County Auditor
LU �/�'
20 0 `�_
Date �
20
We certify 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 properfy on March 1, 20
natu� (owners full name) Person authorized by duly executed Power of Attomey
/j L� or by IC 6-1.1-12-.07
reSs of applicant
13o�C LoZ p/���(�cToN
Address of authorized person