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e`°��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i�-' : FOR DEDUCTION FROM ASSESSED VALUATION � P
Count Townshi Year
S y State Form 43709 (R4 / 10-Ot) .
� Prescribed by Departmenl of Laral Govemment Finance
INSTRUCTIONS: � QN F�elM�7�$02
To be filed in person or by mail with the County Auditor o( the county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 o/the year the deduction is to be ective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the/���a e�ti� ive.
See reverse side for additional instructions and qualifications. GIBSOCd COU'!TY AUDITOR I
Applicant (own or ontrac 6uyer- se s'cti n on rev s side , �,� „ {�
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Taxing Distrid numbe egal description Record number Q
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w �' D- pao�b't..(J Page number ' f/�,
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Assessed value of reat property as of MoAgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March 1, wrrent year owner? � Yes ❑ No
1
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 different than that of applicant, indicate below: Is the property in question:
❑ Real Prnperty ❑ Mobile Hane (IC 61.1-�
, e of mortgagee or contraIX seiler
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Address of mortgagee or contraIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any olher If yes, what wunry? What Taxing Distric[? Has this dedudion been requested on
county in Indiana? property for wrrent year?�] Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
.o�'
20 �}° �' 20 �� 20 0 20 20 20 20 �� 0 9
�y <<3 ��� �g� �- P � P
Signal re County Auditor Dale
�'�' ` e certify under the penalty of perjury lhat the above and foregoing information is true and corred and lhat the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Aftorney
or by IC 6-1.1-12-.07
F resid t address of app' nt Address of authorized person
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