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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
State Form 43709 (R6 / SO6) _
Aesrnbed by Deperiment of Local Gwemmant Finance
1NSTRUCTIONS: Fjl,��riE 9 ZOO)
To 6e filed in person or by mail with the County Audito� 07 the county where the properfy is located.
Filing Dates: 1) Real Property: During the 12 months 6efore �une I1 0/ fhe year the deduction is to be effective.
2) Mobile Homes assessed unde� IC 6-1.1 J: Between January 15 and March 2 of fhe year the deduc�n a bB e�� tive.
See reverse side for additronal instnictions and qualKications. GIBSON COUNTY AUDITOR
Appiicant (oyyier or cont2ct buyer- see
Taxing District
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Assessed value of real property as
March 1, cunent year
on
Key number / legal description
a� ����-�os� 000.���_
MoRgage/Contractindebted
March 1, current year
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Record number e�o� >
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as of Is the applicant the sole legal or
owneR � Yes Q No
If no, what is his / her exact share of interest? '- It owned with someone other than spouse, indicate wifh whom.
If name on record is different than that of applicant, indicate below: Is the propeAy in question:
� Real Properry • 0 Mobile Home pC 61.1-�
N��me oi mortgagee or conVact seller �/�
Address of mortgagee or contract seiler ( umber and street, city, state, ZI' ��� :111'Cl• !\rO _•7/,/, .
.Q� ci� �' _ �G� .
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and stieet, city, state, ZIP wde)
Does applicant own property in any other Ii yes, what county?
wunry in Indiana?
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What Taxing District? Has this deducno�� .,_��n requested on
property tor current year? QYes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 �_ 20 �_ 20 20
P � P
Signature County Auditor
20
20
I I We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20
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Full resident a dress of applicant
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Person authorized by duly executed Power of Attomey
or by IC 6-t.t-12-.07
person