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t"W STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUA gy
. I'4' State Form 43709(R11 16-09) p"1 p .
Prescribed by Department of Local Government Finance JL 11LLJ ��......!!
File Mark
INSTRUCTIONS: NOV 2013 Farm coed with:
To be fled in person or by mail with the County Auditor or County Recorder of the county ere One property is located.
Ming Dates: 1) Real Property Must file during the year for which the deduction is sought. 8 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must hi urirg th tw months
before March 31 of each year the deduction is sought t County Recorder
See reverse side ;additional instructions and qualifi lions. IBSON COUNTY AUDITOR
ey ben I legal description P number
ao-ono-�oo.��s_ i ` oig asp
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of M gage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,artrent year g c -T date of appllalinn legal or equitable owner?
.�IJC.J v ❑ Yes El No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller -�_-- (( a
Addi ad LP code) ^ ,Cl/Ltd
Nan 8013.. ... I
Drawer NO. .
•
Addn ,s I
Card NO. ...:
•
Does: ty? - What Taxing District? Has thisdeduction been requested on property .
count) for anent year?
_ I I ❑ Yes ❑ Na -
I
COUNTY AUDITOR I -
Deduction approved in the amount of.
20 20 20 20 20
120_ 20
' .ly i County I Date(month,day,year)...osa
I 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 application is filed.
reW ( rramal t I Date(month,day,year)
resid nt address of applicant(n r and street ary,state,and ZIP code)
y0 1151 c. 55o S. Frwneisce t 41(-4`tCi
Person audit/deed by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,end ZIP code)