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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R5/ 6-03)
PrescriDed Cy Department o1 Local Govemment Finance
Coun Township Year
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INSTRUCTIONS: File Mark
To be liled in person or by mail with the County Auditor of the county where the propeRy is located. S E P 0 9 2��5
Filing Dates: 1) Real PropeRy: Dunng the 12 months before May 11 of the year the deduction is to be effective:
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the.deductio is-fo be effective.
See reverse side for additional instructions and quali�cati��/ �� / 4/( ���
I _ `FN GIBSON COUNTY AUOITOR
Applicant (owner or p6�ract b/yer- see
Taxing Distrid
`����•���72�'.:�=/a K
value of real property as of
March 1, current year
If no, wliat is his / her exact share of
number / legal description
number ^ �
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/ / /� �// �s'�� Page number / � � /
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Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 7, current year owne(? ❑ Yes ❑ No
If name on record is different lhan thal of applicant, indicate
of.mortgagee or contract seller
Address of moRgagee or contract seller (number and street, city,
Name of assignee or other owner or holder of mortgage
Addressbf assignee (number and street, ciry, state, ZIP
I( owned with someone other than spouse, indicate with whom.
ZIP
Does applicaM own property in any othe-'"--- •°�,� �����ti� J.what Taxina District?
county in Indiana?
Dra�ver NO.,,�,�,0'OS"- �3��
.........
Deduction approved in the amount of: �
Card NO. ... �:��. ll/�. ��
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Signature
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County Auditor
s the property in questfon:
❑ Real Property ❑ Mo6ile Hmie QC 61.7-�
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Has this deduction been requested on
property for current year?� Yes❑ No
zo
Date
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' We certify under the penalty of perjury that the above and foregoing information is true and correct and thal ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
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Si`. �,uCF;a� Tn/
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address ofauthorized person