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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� w� / State Fwm 43709 (RS / 4-03)
PresaiDetl by Department of la:al Govemment Finante
INSTRUCTIONS: File Maric
To be filed in person or by mail with the Counry Auditor of the county where the property is Iocated.�AN � 3 2��6
Filing Dates: 1J Real Property: During the 12 months belore May 11 0/ (he year the deduction is to e e7rective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year the dedu�tion is to be eflective.
See reverse side lor additional instructions and qualificafions. �aO '����
GIBSON COUNTY AUDITOR
(owner
Taxing Dislrid
see
Assessed value of real property as of
March t, current year
If ,io, what is his / her exact share of
Key number / legal description
i� �-�`i-OdS73-pa
Mortgage / Contrad ir
March 1, current year
If name on record is different ihan that of appli�ant, indicate
mortgagee or contrad seller
Address of mortgagee or contraIX seller (number and
Nzme ot assignee or
Address ui assiqnee
Does
owner or holder of mortgaoe
(numberand stre�:!. r.ity; :;tate. ZIP
owo nroperty in any ofh�� ! u•�-;
county ir Indiana?
�
I
-- — — - -- — — --.. .- —
Deducfion appro•�ed in thP amn��v nt.
Record number � L�
7
Page number � Q O
as of Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
7 Soc� �
I Ii owned with someone other than spouse, indicate with whom.
rity. state, ZIP
s•hat ruunty? bVhat Taxing Distnct?
COUNTY AUOITOR
2o�Z Tzn_p�_ ---i -,•c_op zo i zo
—
—!� -- ' -- -- � --J--- �--- �------ �—
Signature ._ .__ __
f:ounty Auditor
Is the property in
❑ Real Property ❑ Mobile Hmie pC fr1.
Has this deduclion been requested on
property for current yea(? � Yes ❑ No
�
Date
zo
v�.'� rrdihj under !n� p,�:,alty of per:��r,- �h.�t thP ahove and fomaoino info:maGOn is hu� and corred and that the applicants was / were
recirient of Indfana and owner o( th� aforementioned propertp on March t 20 __
ire tnwner ti `i'� �
Person a�ithnrized by duly executed Power nf Htiomey
or by IG 6-1.1-12-.07
of aooGCant _ IAddress of authorized person