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} STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
-j??'s}b: State Form 43709(R71/e-09)
Sprescribed prescribed by Department of Local Government Finance 1
Filer M
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TRUC7nper FJANded 1811013
To be h7ed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. II County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought. �it � r fir. 'i'er
See reverse side for additional instructions and qualifications.
GIBS N GOU IV-AUDITOR
APP la'(0. huYer- ontUCLTIl/ , �J���� iZ'L
Tand D" / des ip Rer number Page number
/ /`� - OD- OOo�. s��-tJ� p�O/� .c993
A value areal property as of I Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is tie epplit the sole
Mardi 1,cement year I MMaarrdd�i 1I.current year date of aPP1ce,1 D Iagal on equitable El N
t/-/ cap ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If awned with someone other than spouse,indicate with whom
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If name on record is afferent than that of applicant,indicate below. i property in question:AnruwOyAssessed
eel Property ❑Annually Assessed
/] ��/i Ste.-- Mobie Home(IC 6-1.1-7)
Name of mortgagee or contract seller "l . /r'C 44-
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Address of mortgagee or contract seller(number and stye` ,'tarp,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant awn property in any other If yes,what county? What Taxing District? Has this deduction been requested an property
county m Indiana? ❑ Yes El No for cement year ❑ Yes ❑ No
® - COUNTY AUDITOR
Deduction a
r-
o 20 20 20
Dra11-et• 1\'O.. G-11'(/Jl Date(month,day.year)
sgriatrrre a ........
r n........ County
I I We Ca.rd j !N O. J 7g 2 ig information is true and correct and that the applicant is a resident of Indiana and
owner ................•,/... ation is filed.•
Sig -, (owner's flu ne Date(month,day,year)
Full resident address of applicant(number and street sty,state,and ZIP code)
—72-17-2 a) itin S 4.0,6#7,57,4/ . /A./ 4/74e,/,S-
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,S and ZIP code) .
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