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e��° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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i+ : FOR DEDUCTION FROM ASSESSED VALUATION
S�y State Form 43709 (R4 / 10-07)
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Prescnbe0 by Depannent of Local Govemment Finance
INSTRUCTIONS:
Count � Township Year
F' e Mark
To be filed in person or by mail with lhe County Auditor ol the county where the propeRy is located. � � T � y 2QQZ
Filing Dates: 1) Real Property: Dunng the 12 months be/o2 May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.7-7: Between January 15 and March 31 0l t e year the d uqfipn is to e e ctive.
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See �everse srde for additional insf�uctions and quali�cations_ ��
GBSON COU�T�" AUDITOR
Applicant (owne� contra t yer- see stn ions o reverse side)
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Taxing Distnd Key number / legal description Record number ��
/ n^ �l(J� �D \'W /��'�� Pagenumber •CO(D
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Assessed value of real property as of MoRgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcenl year March 1, current year ,lf8 �� D ownef? ❑ Yes ❑ No
�OOoD �
Ii no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�'ame of mortgagee or wnlrad seller
Address of mortgagee or contrad seller (num er and street, city, s ate, ZIP �� `'
Name of assignee or other owner or holder of mortgage
Address o( assignee (numberand st2et, city, state, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current year?�] Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount Qf:/ �
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Signature County Auditor Date
�! We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
i resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (own�rs (ull name � Person authurized by duly executed Power oi Attomey
�� or by IC 6-1.1-12-.07
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Fu I resi ,r�� gQcjr�oo�p�� � r�����s�� ��76y Address of aulhorized person
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