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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION un o ns 'p Year
� �w� ! State Fwm a3709 (RS / 4-03) . �
� PrescriDed oy Department nf Local Covemment Finance � E 2 7 2005
INSTRUCTIONS: �u�qi�
To be filed in person or by mail with the County Auditor of the county where the property is located. GIBSON U
COUNTY AUDITOR
Filing Dates: 1) Real Property: During fhe 12 months befo2 May 11 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year the deduction is to be effecfive.
See reverse side for additional instn�ctions and qualifications.
or contract buyer - see ,
. .�- --- ' 4-
Taxing Distrid
c� 9-o a �s �- �
Assessed value of real property as of
March 1, current year
on reverse
Key number / legal
Mortgage / Contract ii
March 1, current year
Record numbero � _ �
Page number
� 7
as of Is the applicant t sole legal or
owneR es ❑ No
I /c3/00d
If ,io, what is his / her exad share of interesl? � If owned wifh someone other than spouse, indicate with whom.
�
If name on record is different than thaf of applianl, indicate bel��w: Is thg,property in question:
of mortgagee or conlract seller
Address of mortgagee or contred seller (number and street, city. state, ZIP
Name of assignee or other owner or
mortGaae
adaress m assignee (numberand st2et.. r.ity, st�te. Z!P code)
y ❑ Mobile Home QC fr1.1
�E,� 1�a,n�v r
�SR2✓1I � ��" /hucr"7(_
O5.-�ll�
Does apDlicant ovm nroperty in any oth�r I If •��; yhat county? bVhat Taxing District?
wunty ir Indiana? �
I
- ---- - - _ _-- - ._:_ ...
J � /� COUNTY Al1DITOR
�_f� �LZJ � "' �" — —
Deduction approved m ihe am��mt nt:
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Z�
SignaWre
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I
-.'--._ . .--- - ----- ------ -I—
_ ,_ __ __ County Auditor
Has tms �o..�,.,.,,.. _ _ _ ;quested on
property for wrrent yeaR � Yes 0 No
20
Date
20
1hir. rFrtif�j under Ihn. � anaBy of peri��• �h�� Ine above and forr.aoina info:maYOn is hue and corred and that ihe applicanis was / were
�esirir.nt of Indiana ard owner of tho afnremenfioned p�operty on Maroh L 20 __
`,r �:am;�)
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ss of aoolicant
Person a�ithnrized Ay duly executed Power of Nttomey
or by IG 6-1.1-12-.Oi
Address of authorized person