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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fofm 43709 (R4l 1P-01)
PrescribeC by Departmenl o; Local3ovemmeni Finance
INSTRUCTIONS:
To be filed in person or by mail with fhe County Auditor of the county whe2 the praperty is located. J� N 2 7 2003
Filing Dates: 1) Real Property: Dunng the 12 months be7ore May 11 0l the year fhe deduction is to be ef/echve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0( the �ar the d,edu�ction-is to be eHe/ct�ive.
See reverse side /oradditional instructions and qualifications. /�� '' `�����_'(/'/
GI3SON COUNTY AUp;TGR I
Taxing Di3trid '
�.���.
Assessed vatue oi real property as of
March 1, current year
reverse
Key n�fijber / legal
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Record number � � �
M �-�� l'1 �O Page number ,/ 2D n
ISE.bC pe �7� d �
Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes � No
Ii no, what is his / her exad share of interesl? 5f owned with someone other than spouse, indicate with whom.
- /3 -�o - oo - 000. 3ia -Da�
If name on record is different Ihan lhat of applicant, indicale betow: Is the property in question:
❑ Real PropE�rty ❑ Mobile Home QC 61.1-�
�me of mortgagee or contract seller ,
Address of mortgagee or contrad seller (number and stieet, city, state, ZIP -
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
counry in Indiana?
approved in the amounl of:
20 Q� 20
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Signature _
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Drawer N � o
lDO AOO�ov ' .......
What Taxing DisU � • • • • • "' ��
Card NO��� No
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COUNTY AUDITOR
20 � 20 �
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County Auditor
20�� 20� 20
P P
Date
We certify under lhe penalty of perjury that the above and foregoing information is lrue and corred and thal ihe applicants was / were
resident 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
5p j� W�/ _� �Address of authorized person