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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R6 / 5-06) . . : ;. ..
Presaibetl by Depanment of Lo�al Gwemmen� Finance , �
INSTRUCTIONS: � �
To be filed in person o� by mail with the County Auditor of the county whe�e fhe p�opeRy is located. 2007
Filing Dates: 1) Real P�ope�ty: Dunng the 12 months before June Il of the year the deducfion is to 6� �ecLv�.
. 2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the yea� the deduction is to be elfective.
See �everse side fo� additional instnictions and quali(rcations. �6� ��
I 1nrtOR
GIBSON COUn� � ^"--
Applicant (ow rorcon�r- see restnc6ons on reverse side) • �p�1
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Taxin Dislr' Key number / legal description Record number
��'��'/Yt�Cc�C�v.' (O-/at�0%-�-D/-00/. �SG pagenumber '
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Assessed value of real property as of Martgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year : March 1, wrrent year • owner? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicani, indicate below: Is the property in question:
. ❑ Reat PropeAy ❑ Mobile Hane QC 61.1-n
me of mortgagee or conlrad seller �x-O ��""c' /,`
Address of moRgagee or conVact seller (number and street, city, state, ZIP . __
Name of assignee or other owner or holder of mortgage ' ����: � �•L,ji�� y,_
Address of assignee (numberand street, city, state, ZIP code) j/ -��-�-'�G�`-� �
Does applicant own property in any other If yes, what counry? What Taxing D% I�u, 'KI '�L�`I` �, � i
county in Indiana? N,��,,, �_� g5, ��n • ;o
COUNTY AUDITOR
Deduction approved in the amount of:
2o b zo 20 20 : zo zo zo
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Signature County Auditor Date
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We certiy under the penalty af perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
resident of Indiana and owner of lhe aforemenlioned property on March 1, 20
� Signature (owners full name) Person authorized by duly executed Power ot Attomey
1 w�� /� . �� � w or by IC 6-1.1-12-.07
/ Full r ident address of applicant , , Address of authorized person
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