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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 C mm�ssioners �.
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Instructions for filing: z�-�
To be fiied in person or by mail with the County Auditor of the county where the
property is iocated during the 12 months before May 11 of ihe year the deduction
is to be effective. See reverse for additional instructions and qualifications.
or
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restrictions on
Key Number/Legal Description
Filin fee $1.00
County� Township Year
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A�it��l�`�99
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GIBSOt� C�titiTY AUDITOR
Record No
""tJ �105-7 (.CJ Pac1e No.
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Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the.applicant the sole legal or
of March 1, current y�ar as of March 1, current year. � equitable owner? O yes � no
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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:
"�me of mortgagee or contract seller
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Address of mortgagee or contract seiler ��� C/�
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or other owner or holder of Mortgage.
Address of Assignee
Does applicant own real property I If yes, what
in any other county in Indiana?
approved in the amount of
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Signature I
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What Taxing District?
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of Review
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Has this deduction been
requested on property for current
year? ❑ yes O no
19 �� I 18-a2opo,�
1
Date
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I/We certity under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�,ts waslwere a resident of Indiana and owner oi the aforementioned property on March 1, 19
naturg�(owners full name) Person authorized by duly executed Power of Attorney or
V �� !,_/ ��� n.R��� by IC 6-1.1-12-.07).
isideni Address of Aplic�(it Address of Authorized Person
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