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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09)
Presuibed by Department of Local Government Finance
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INSTRUCTIONS:
To be filled in person or by mail. orm iled wi :
Filing Dates: 1) Real Property Must be completed and dated in the calendar yea� fo� �vhich fhe deduclion is soughl.
Must 6e filed with Ihe County Audifor or County Recorder o/ [he counry where the propeRy is located � C ditor
on or 6efo2 January 5 0/ the immediafely succeeding calendar year. Recorder
2) Mobile / Manu7acfured Homes nof assessed as Real Property: Must file with lhe County Audi(or o/ lhe GIBSO
crounty where the propeRy is located dunng Ihe hveNe (72) months before Ma�ch 31 0/ each year the
deduction is sought.
ApplicaN (owner or conirac7 buyer - see
Gary Jones and Janet Jones
AssesseQ value of real property as
March 1, cunent year
no.
name on
rvame ot mongagee or convaa sener
Evansville Federal Credit Union
Address of mortgagee or wnt2ct seller numb�
6209 Vogel Road, Evansville, IN 47715
or omer owner or
Does applicant own properry In any
counry in Indiana?
❑ Yes
on �everse
number/ legal tlesc�ption 26-17-Ot-400-003740-021 / 6584 W. NoRh Kecom num
Owensville, Indiana 47665 Q/ �
Mortgage / Contract Inde6tedness unpaid as of Mortgage / Contract indebtedness unpaid as
March 1, wrrenl year
5159,650.00
application
If owned with someone oNer than spouse,
the applicant the sole
�al or uitable owner?
Yes ❑ No
pertyin Quesfion: Annualty Assessed
Property ❑ Annually Assessed
Mobile Home pC 6-1.1-
deduction been requested on pwperty
nt yeaR �
T]'Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 _ � 20 _ 20 _ 20 20 _ 20 _ 20
SignaWre of Counry Autlitor Coanry Date (month, tlay, yea�
� I/ We certify under penalty of perjury thai ihe above and foregoing information is true and correct and that the applicani is a resident of Indiana and
-bwner / contraci buyer of the aforementioned property on date application is filed.
Signature ( wner's /ull n me) Date (month, day, yea�
-2O/3
Full resident ad r s applicant (number and streel, ciry, state, and ZIP code)
6584 W North St.. Owensville, IN 47665
Perwn au[horized by duty exewted Power of Aitomey or by IC 64.7-12-07 Date (monlh, dag yea�
Address of authorized person (number antl stree(. ciry, sfate, and ZIP code)