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,.;*��Fa STATEMENT OF MORTGAGE OR CONTRACT
3�a:� ` INDEBTEDNESS FOR DEDUCTION FRdM ASSESSED
", ' VALUATION State Form 43709 (1-90) Prescribed by the
�6 ` State Board of Tax Commissioners
`� t �
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county N�here the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
(Owner
axing District
see e ictions on
I Key Number/L <
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1
MAY 0 8 1997 ';
� GIBSON COU TY AUDITOR
Record No.
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Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of Marc� current ear. equitable owner? O yes O no
J
If no, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below: �—/,,�—p�G-l�/ �� �
of mortgagee or contract seller
Address of mortgagee or contract seller
Name of Assignee or other_�•••-�
_ �D�ey
Address of Assigr �'p
Does applicant ow� � b� e.�
in any other county
Mortgage.
unty? What Taxing District?
1
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Has this deduction been
requested on property for current
year? ❑ yes ❑ no
Secretary of Board of Review � DateQ %
�3- �6 �
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° 9
certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
iture (owners fufl name) . Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07):
Address of Aplicant I Address of Authorized Person