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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the
property is located during ti�e 12 months before May 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
Taxing ' trict!
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rest�tions on reverse)
Key Number/Legal Description
o / 9- o�.r"��-
f�e $1.00
Township Year
- � � , y1,1=��'!
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GlBSON
Record No.
Paqe No.
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes O no
��, d-a�
If no, what is his/her exact share or interest?
If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
of
of
contract seller
or contract seller
Name of Assignee or other owner or
Address of
:
Does applicant own real property If yes, what county? What Taxin� District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approveii in the amount of:
1 g t��
Signature
/ �� ��G
/lJ "' !l �
1 �L(� I � pD1 � 03
19
I g y � 1 ! ��s:L• � r ► � �� � ��� � F : - �
. :.. . . - � . -
. . + � . 1 i �
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IIWe certify under penalty of perjury that the above and foregoing irrformation is true and correct and that the appli-
•� � was/were a resident of Indiana and owner of the aforementioned property on March 1, 19 .
S�gn e(owners full n Person authorized by duly executed Power of Attorney or
, � ,(���� by IC 6-1.1-12-.07).
Full Resident Addr�s of Aplic�t / J � Address of Authorized Person