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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R6I5-O6)
Presaibed by Oepariment of Local Gwemment Finance
Count Township Year
INSTRUCTIONS: File Mark
To be �led in person or by mai/ with the County Auditor of the county where the property is located. ��� ��
Filrng Dates: 1) Real Properfy: During lhe 12 months before ,lune 11 of fhe year the deduction is to b e ec e.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the year th o ctive.
See reverse side foi addifiona! insfruc6ons and qualifications. APR 3 p 2007
a - -, - �03- oo � -
Applican�wner or cont2cf buyer - see iestri ' ns on reve�se side) d!j �
GIBSON C � �
Taxing District Key number I al description Record number
.1`�� Page number a�
P�Um-en�rn�, d�O-�a-lo3- -o I
Assessed value oi real property as of Mortgage / ConUad indebtedness unpaid as of is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? �Yes � No
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If no, what is his / her exact share oi interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that oT applicant, indicate below: Is the property in ques6on:
eal Property 0 Mobile Home QC G1.1-7)
� oi mortgagee or contract seller .
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Address of mortgagee or contract seller (number and street, city, state, P
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and straet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deducdon been requested on
county in Indiana? property for curteni year? ❑Yes❑ No
COUNTY AUDITOR
Deduc6on approved in the amount of:
20 �_ 20 Q� 20 � 20 20 20 20
(� � P
Signature County Auditor Date
I/ We certify under the penalry of perjury that the above and foregoing infortnation is true and cortect and that the applicants was / were
ident ot Indiana and owner of the aforementioned property on March 1, 20
ignatu ner's full na e) Person authorized by duly executed Power of Attomey
�, or by IC 6-1.1-12-.07
Full resident addres of applicant Address of authorized person