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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm 43709 (RS / 4-03)
PrasaiEetl by Department of Laal Govemmem Finance
INSTRUCTIONS:
To 6e filed in person or by mail witA the County Auditor of the county where the property is located. (� j
Filing Dates: 1J Real Property: During the 12 months be(ore May 11 of the year the deduction is to be e7%ofive $ Z��3
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ t7�e year the deduction is to/b�e e8ective.
See reverse side for additional instructions and quali�cations. j5 �. , �,J� ,. [,r ,�% -
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� ' GIBSON COUNTt' FUDITOR
Applican ( ner or contrac buy�er - s resMctions on reve ide)
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Taxin/g'� istrict Key number legal description Record number Q�
�tJL�k� � • / / 'Y,, r Od / �/`� Page number
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Assessed value of real property as af Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, cunenl year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC E1.1-7)
�ne ot mortgagee or contract seller
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Address of mortgagee or contred seller (number and street, city, state, 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 county? What Taxing Districl? Has this deduction been requested on
counry in Indiana? property for curreni year? ❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 r� 5 20 (LC� 20 20 �� 20 _� 20
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Signature Counry Auditor Date
�e certity under the penaity of perjury that the above and foregoing information is Irue and correct and that the applicants was / were
sident of In ' na and owner of the a e ntioned property on March t, 20
Si natur (o n rs full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu I resi ent ddress o applicant Address of authorized person
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