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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
+ I State Fwm 43709 (RS I 4-03)
� �M�
P2s[riGed by Department of Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
ile Mat'k1
To 6e fi/ed in person or by mail with the County Auditor of the county w6ere the property is located. jj'"1 ����
Filing Dates: 1) Real Property: During the 12 months before May 71 of the year the deduciion is to be �iiect� ��
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is fo be eHective.
See reverse side for additional instructions and qualifrcations. FEB � 5 Z���
Applicant (owner
Taxing Distrid
see restrictions
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
If name on record is diHerent than that
me of mortgagee or
ot
side)
Key number / leg
?� -ao- a�_�
�� � -�v�
GIBSON
Record number
�!j -000, 5 y� -oof�
4 /1 � Page number
/
Mortgage / Conlrad indebtedness unpaid as
March 1, current year
`J�.J/VV.�
indicate below:
Is the applicant the sole' legal or
owneR ❑ Yes ❑ tJo
Ii owned with someone other than spouse, indicale with whom.
of mortgagee or contrad seller (number and st2et, city, state, ZIP
or other owner or holder of mortgage
of assignee (number and
Does applicant own property in any
wunty in Indiana?
20
Signature
approved in the amount of:
20 �$_
�
state, ZIP code)
If yes, what county? � What Taxing District?
COUNTY AUDITOR
20 � 20 20
f
�_ County Auditor
s lhe property in question:
❑ Real PropeAy ❑ Mobile Home QC 61.1
Has this deduction been requested on
property for current yea(? � Yes ❑ No
20
Date
3�7
We ceAify under the penalty of per�Lry that the above and foregoing information is true and wrred and that lhe applicants was / were
'esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duiy
or by IC 6-1.1-12-.07
ofauthorized person
Attamey