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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ «. ! State Form 43709 (RS I 4-03) '
• Prescnbed by Department o/ Loral Govemment Finance
INSTRUCTIONS: - . � API�'�q"��006
To be filed in person or 6y mail with the County Auditor of the county where [he propeRy is located.
Filing Dates: 1J Real Property: During the 12 months belore May 11 o(the year the deduction is to be effective:
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the de,,�d�ticv1 i��tig, effective.
See reverse side Ior additronal instructions and quali�cations. GIBSON C UNTY UDITOR
Applicanl (owner or
Taxing Dislrid
buyer-
reverse side)
Key number / legal description � Record
Qi[� I�/�/C1 I O ]_/h/\ Page number S
V� vl/ rn «�
Assessed value of real propeiiy as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole lega or equitable
March 1, wrrenl year March 1, current year ownef? ❑ Yes ❑ No
V C./
If no, what is his / her exact share of interest? Ii owned wilh someone other than spouse, indicate with whom.
o?�- a-��3�a-6ao./o�--oo/
If name on record is different than IF�at of applicant, indicate below: Is the property in queslion:
,me of mortgagee or contract seller �(�
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage .
Address ot assignee (number and st2et, ciry, sfate. ZIP code)
Does applicanf own property in any
wunty in Indiana?
Deduction approved. in the amount ot:
20 �'\
Signature
r�
� Real Property ❑ Mobile Home pC 6-1.1-�
yes, what county? What Taxing District? Has this deduction been requested on
property for current yeaf?❑ Yes� No .
20 �$_ 20 ,Q
P P
� ��
COUNTY AUDITOR
�
County Auditor
20
20
Date
20
ify under the penalty of perjury that the above and foregoing infortnation is true and corred and thal ihe applicants was / were
of Indiana and �own�e�of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person