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,; ""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
ji' �. FOR DEDUCTION FROM ASSESSED VALUATION
«. / State Fam 43709 (R6 / 5-06)
� Presvibed by Department of Local Gwemment Finarice
INSTRUCTIONS:
To be filed in person or by mail with lhe County Auditor of the county where the property.is locafed. QC T 1 1 Z��)
Filing Dates: 1) Rea/ Property: Du�ng the 12 months before �une I1 of the year the deduction is to be effective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 o/the year fh�uctlonj,s�be elfectrve.
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See reverse side /or additional instruc6ons and qualifrca6ons. GIBSON U
COUNTY qUD170R
Applicant (own
Taxin9 Distri�
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Assessed v�
March t. wrr i
buyer-
propeAy
restrictions
Key number / legal description Record number
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Page number �
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MoAgage / Contrad indebtedness un id as of Is the appliwnt the sole legal or equitable
March t, current year ��,f.hi owneR ❑ Yes 0 No
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If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is t e property in question:
Real Property p Mobile Hmie (IC 61.1-�
�e of mortgagee or conVact seller ��
Address ot moRgagee or conVad seller (nu er and street, ciry, state, ZIP
Name of assipnee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applieant bwn property in any other I If yes, what county? What Tar
county in Indiana?
Deduction approved in the amount
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Signature
COUNTY AUDITOI.
20
County Auditor
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Dra���er NO ���5: ��a`S
�sled on
es� No
C rd NO . . ... ............ o0
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20
20
certi(y under lhe penalty of perjury thal lhe above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
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name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person