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EMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form a3709 (RS / 4-03) .
PresviDed by Department of Local Govemment Finance
Coun Townshi Year
INSTRUCTIONS: . ' MAR OF� �
To be filed in person or by mail with the CounryAuditor of the county where the property is located.
Filing Dates: 1) Reai Property: During the 12 months be/ore May 11 0l the year the deduction is to be eNective. '��"
2) Mobile Homes auessed under lC 6-1.1-7: Between January 15 and March 2 of the yeai fh�,g "dQdu� uarr�s� be effective.
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See reverse side (or additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant (owner or contract b�yer - see resfriclions on reverse'side) `
Taxing Oistrid Key number / gal description Record number
� ' ' Page number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the apptican t�sole legal or equilable
March 1, current year March 1, current year owneR es ❑ No
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If no, what is his / her exact share of interest? If owned wilh someone other lhan spouse, indicate with whom.
It name on record is different than that of applicant, indicate below: Is the property in question:
eal Properiy ❑ Mobile Home QC 61.1-�
me of moAgagee or conVad selier
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Address o( mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder oi moRgage
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Address oF assignee (numbe�and street, city, sfate, ZIP code)
Dra�r�er NO ...................
Dces applicant own property in any other If yes, what county? \ r :n requested on
county in Indiana? Card � � . ..................... af�[� Yes� No
COUNTY A �
Deduction approved in the amounl of:
20 �1 20 �_ 20 �_ 20 20 20 20
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Signature County Auditor Dale
/ We certify under the penalty of perjury fhat the above and foregoing infortnation is true and corred and ihat ihe applicants was / were
-.t residenl of Indiana and owner of the aforemenlioned property on March t, 20
Signature (owners /ull name) Person authorized by duty executed Power of Attomey
� r or by IC 6-1.1-12-.07
F II ' �den adtlress applicant Address of authorized person
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