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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S�ale Fortn 43709 (R4 / 10-01)
Prescribed by Department of Loral Govemmem Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Audifor of the counfy where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 of the year the deduction is to be effectiv�P R 1� 2002
2) Mobile Homes assessed under IC Ef.l-7: Behveen January 15 and March 31 0/ the ye the deduction i. to be etfective.
See reverse side lor additional insGuctions and quali�cations.
GIBSON COUN?" tiUDITnR
Applicant (owner contract buyer - ee tions on reve e e)
Taxing Distrid Key number / legal des iption Record number �
\�����'— ` �0�—V������ Pagenumber (/'/�
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Assessed value of real property as of MoAga e/ Contracl indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March�rent year ownef? ❑ Yes ❑ No
\��o c�o c�
If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobile Hane QC fr1.1-�
�me of moRgagee or contract seiler
Address of mortgagee or contrac[ seller (number and stieet, crfy, state, ZIP '
Name of assignee or other owner or hoider of mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applirant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for wrtent year? 0 YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 0 20 Q� 20 m� 20 20 ��
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Si ature County Auditor Date
I/ We certity under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
igna re (owners full name ( ,, Person authorized by duly executed Power of Atlomey
� � �7"` or by IC 6-1.1-12-.07
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Full resident address ot applicant Address of authorized person