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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R6 / 5-06)
Presaibed by Depertmenl of Loml Govemmant Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor ol the county where the propeRy is located.
Filing Dates: f) Rea/ Property: During the 12 months before June Il o/ the year the deducSon is to be eff�ye. O E 2007
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side fo� additional instnictions and quali�cations. �"l"f ���
GIBSON COUNTY AUDITOR
Applicant (owner or contract buyer - see iesfrictions on reverse side)
Taxinng District Key number / legal description Record number
�Y.l� ��_ I 'O�_ — ��,Q^� Pagenumber ���
1 d
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? Q Yes � No
3 oa�
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on rewrd is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mob� Home (IC 61.1-7)
�'�me of mortgagee or contract seller Q��
Address of moRgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
c
Address of assignee (number and s[reet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? VJhat Taxing District? Has this deduction been requested on
wunty in Indiana? property for wrrent year? Q Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20� 20 � 20 Q� 20 20 20 20
p � i
Signature County Auditor Date
I I We certify under the penalty of perjury that ihe above and toregoing infortnation is W e and correct and that the applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20
,..ynatur (owners /ull me) - Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident ress o app icant � Address of authorized person �
8 �1� � �► u 26 O �