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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RS I 4-03)
P2scnEed by Department of Local Govemment Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the Counry Auditor ol the county where the property is located. � E �� 6 20�4
Filing Dates: 1) Real Pioperty: During the 12 months be(ore May 11 0/ the year the deduction is to be echve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oI tAe y the deduc 'on to be e ecti e.
See reverse side for additional instructions and qualiTcations.
GIBSON COU TY AUDITOR
(owne� or contract buyer- see
Taxing Distrid
Assessed value of real property as of
March t, wrtent year
no, what is his / her exact share of interest?
If name on record is different
on reverse
number /
V�� � r l� 1 �> —1 L�
M rto gage / ContraU indebtedne
March 1, current year �(� 51
that of applicanf, indicate below:
of mortgagee or contrad seller
Record number
Page number
as of Is the applicant t e sole legal or equitable
00 owner? ❑ No
If owned with someone other than spouse, indicate with whom.
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Address of mortgagee or contrect selle��number and street, city, state, ZIP
of assignee or other owner or holder oi mortgage
ot assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? ( What Taxing Di�
county in Indiana?
ueauaion approvea m the amount of:
20
Signature
20
COUNTY AUDITOR
20 � 20 0 `•1 20
Q P
County Auditor
property in questian:
❑ Mobile Home (IC 61.1-
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20
Date
20
ceAify under the penalty of perjury that the above and toregoing information is true and corred and that the applicants was / were
ent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person