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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Year
�,;: FOR DEDUCTION FROM ASSESSED VALUATION
t� State Form 43709(R11/609)
_' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: i - _ - r
ion r
W3 be filed 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 .u Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months , I/
before March 31 of each year the deduction is sought.
'• T 9t'?i r. Recorder
GIBSO . .
See reverse side for additional instructions and aannd gq/uuealificationnss. �j/�J,, �I n " "
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Assessed value of realg7RR9y as Mortgage/Contact Indebtedness unpaid as of Mortgage I Conrad indebtedness as of Is the applicant e sole
March 1,anent year /r y// March 1,anent year date of appri a legal or equitable owner?
/ rr� ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone otZtfon spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
-
Name of mortgagee a contact selle / oe
•
Address of mortgagee or contract seller(number arid street city,state,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 own property in any other If yes,what county? - What Tatting District? Has this deduction been requested on properly
county in Indiana? ❑ Yes ❑ No __ for current year? ❑ No
❑ Yes
COUNTY AUDITOR
Deduction approved in the amount at _
20 20 20 20_ 90/3 20
Drawer N O.
Signore of Canty Auditor (ln'/� ')
I I We certify under the penalty of perjury that the above and foregoing ink Card \0. •�• •T••••'''' of Indiana and
owner I contract buyer of the aforementioned property on data application
�(own @rs ruff rte ) h
��->��� 1
ent address o appfcant(nu betand street city,state,and ZIP e)
{ al Ocr�u La e �n"rte on CTN y76 70
Person authorized by duly executed Power of Attoey or by IC 6-1.1-12-0.7 /
rn Date(wrath, year)
Address of authorized person (number and street dry,state,and ZIP code) .