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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township L Year
FOR DEDUCTION FROM ASSESSED VALUATION
t State Form 43709(Rit/6-09)
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Presrnbed by Department of Local Government Firw¢e
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INSTRUCTIONS: g ���raaa...{���ddd
RI be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. F 1 F Y c: 2013
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought _LLI 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 /kJ • Co my
See reverse for additional instructions and qualifications.
Applicant( etorconfaf Wee �/ (r; �+IBSON COUNTY AUDITOR
Ta V‘11-1 r/ desai•:- Record number Page
07/ —o'- -- oo x/4c7/- D / do/3 33 z
4 •property if f Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,cement year date of application 2 legal or equitable owner?
/� // ❑ Yes ❑ No
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If no,what is his I her exact share of interest? If other owned with someone oth than ,indicate with whom
If name on record is different than that of applicant indicate below \ ,Is,{qe property in question:Annually Assessed
�LJ'Real Property ❑Annually Assessed
/ n Motile Hone(1C 61.1-7)
Name of mortgagee or contract seller 0 �/ J/1 `�
Address of mortgagee or contract seder(number and street cityy.sta!ter,and ZIP code) /J
Name of assignee or other owner or holder of mortgage 2e j // 1
Address of assignee(number and steer,city,state,and ZIP code) f/^/U`f9 /�
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current yeah ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the arnount at_pp ^_.o'l
20 BURR scres _ 20 20 20
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Signature of County P :Purity Date(month,day,year)
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I/We certify unc stlon is true and correct and that the applicant is a resident of Indiana and
owner f ntract led.
�ItI�\ Signature o ers its Date(month,day,year)
tF `/�''/nt address of apjWtani --- -. e7 rand suee4 dry:state,and ZIP code) ' r /
Ili )A kJ 57-s-
' / S 0,41e'1 t o- -f, �. `1716 5"-
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 r Date(month,day,year)
Address of marked person (number and steer,city,state,and ZIP code) .