Mortgage_Bailey (3)�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�• w� / State Fwm 43)09 (RS / 4-03)
� Presai�ed by Oepartment of Local Govemment Finance
Coun Township Year
� ,
INSTRUCTIONS: � � ���
To be filed in person or 6y mail with the County Auditor o! the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months betore May 11 0/ the year the deduction is to be �aiv� 5 Z���
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to 6e effective.
See reverse side /or additional instiuctions and qualifications �G,u Q��
� �� GIBSO� C UNTY qOUpi7nw
Applicant
T
Assessed value of real property as
March 1, current year
Key ber / legal description `
a �a-a9-icb -cbo.lu
Z'Oa-ceo� 1- �d
Record
?age
Mortgage / Contract indebtedness unpaid as of Is the applicant th ;ole ega� .`�i
March 1, rent year ownef? �. es ❑ No \
��� ��
If no, what is his / her exac[ share of interest?
If name on record is different than that of applicant, indicate
mortgagee or contract seiler
If owned with someone olher than spouse, dicate with whom.
Address of mortgagee or contracl seller (number and st2et, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address
and street, city, state, ZIP
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
�
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Deductionapprc DI':1��'�t'\�.�Y.Y..!...�..
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20
� �/� `/%�, Go — 1�
Signature
County Auditor
question:
❑ Real PmpeAy ❑ Mobile Horne QC 6-1.1
,���Y
Has this deduction been requested on
property for current yea(? � Yes � No
3�7
Date
20
certify under the penalty of perjury that Ihe above and foregoing information is true and corred and that lhe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
�x �� ��
Person authorized by duly
or by IC 6-1.1-12-.07
om auwcaa ui appucem Address of authorized person
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