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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R4 / 10-0i )
Prescribe0 by Departmenl of Local Govemment Fnance
Count Township Year
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INSTRUCTIONS: F'le Mark
To be filed in person or by mail wifh the County Auditor of the county where the property is located. MNK 2� 2��3
Filing Dates: 1) Real Property: During the 12 months betore May 11 of the year the deduction is to be e/fective. �
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 oI ttuie year the d"duc/tien is to e ctive.
See 2verse side for additional inst�uctions and quali�cations. �%`"'`'�J`�'���
GIBSON COUNTY AI�DITOR
Applicant (o 0 2 buyer- se stricti ns re erse side)
Taxing District Key number / tegal desc' ' n ecord number �
/ / /%� � h � ? Q �n-\ Page number
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Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curtent year owner? ❑ Yes ❑ No
QOOO�
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan lhat of appticant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Mobile Horrre (IC Cr1.1-�
rne of mortgagee or contract seller
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Address of mortgagee or contract seller (number and stre , city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, whaf county? What Taxing District? Has this deduction been requested on
county in Indiana? property for wRent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� zo � 20 � zo � za .r7 �/ zo �� zo �
o � � P i'
Signature County Auditor Date
' We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and lhat the applicanls was 1 were
�esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Futl resident address of applipnt Address of authorized person