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. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
c.:_,-.
" �;:_ FOR DEDUCTION FROM ASSESSED VALUATION
1 state Form d 43709 Depm 7 ent of � I Ii)
Prescribed by DeParuronl of Local Government Prorate
INSTRUC77ONS:
N
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located. I I'tForm filed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. I V
`County Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months ❑
before March 31 of each year the deduction is sought /t, er
See reverse side for additional instructions and qualifications. ,/N/1�
GIBSON COUNTY AUDITOR
Ap..,(-; t(owner acontrail buyer-see on a=verse side)
g• 4
T istrict number/legal desaiption Record number Page number
YiZ(./ft,c cnz , . le2 _O(o - gag{ -coo . (nos - o 8 / 3 a 930
Assessed value of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appricant the sole
Mardi 1,anent year March 1,are year date of application legal or equitable owner?
�D Qom ❑ Yes ❑ No
If no,what is his/her exact share of interest? r If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of apprrant,indicate below. is the property in question:Annually Assessed
El Real Property ❑Annually Assessed
\ Mobile Home(IC 6-1.1-7)
Name of mortgagee a contact seller O-C��'''' 71,d-rj-t.
Address of mortgagee or contract cpnpr(number and meet city,state,and ZIP code) _: :•=:T`.d^",ate_:.:�i:eey ;,`",_ :..�_.,_
6kINE:S1 U4r/1i}nisi-3.
Name of assignee or other owner or holder of mortgage T• Mr r��y ""'(
Address of assignee(number and street,city,state,and ZIP e) 171M ,l or rZL 7W^ J
Does applicant any other If yes,what county? • What Taring District? CI , 1-s1 d--NO. - �°�T93 0
county in Indiana?
❑ Yes ❑ No
COUNTY AUDITOR \
Deduction approved in the amour of •
-
i
20 20 20 20 20 20 20
Sigraaf u Ntiur Auditor . �� County Date(month,day.}ear)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date applicatlon,is filed.
is re :) ' /) . 0 /�� Date(month,day,year)
A- �� �-a e.
,k,..�fare9dent address of... .,.• umber •^et je.arM9Peptle C L en 1� )A1- f ((D V
--full
i rsonVrauthoo`rized by ydduly executed Power off can
or by IC 61.1-122-0/.7(-(, Date(month,day,year)
Address of a Woaized person (number and meet dry,State,and ZIP code)