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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (Ra I 10.07)
PrescribeE by Deparirtren� of Local Govemment Finance
Coun Township Year
�
INSTRUCTIONS: �jil Mark
To 6e filed in person or 6y mail with the CountyAudiforolthe county where the property is located. APR 1� 20�2
Filing Dates: f) Real Property: During the 12 months before May 11 0/ the year the deduction is to b Hective.
2) Mobile Homes assessed under IC 6-1. 7-7: Behveen January 15 and March 31 ot th ear th de cfi is to b e/f tive.
See reverse side lor additional instructions and qualifications. GIBSON COUt TY kUDi70R
buyer-see
Taxing Distrid
�
side)
number / legal
L. —
Assessed value of rkyll property as of Mortgage / Contract ir
March 1, current year March 1, current year
Ii no, what is his / her exad share of interest? '
If name on record is different than that of applicant, indicate below:
of mortgagee or coniract seller
Address of mortgagee or conVact seller (number and
Name of assignee or other owner or holder of mortgage
as
Record number
Page number
is the applicant the sole legal or equitable
ownef? 0 Yes ❑ No
If owned with someone other than spouse, indicate wilh whom.
city, state, ZIP
Address of assignee (number and street, city, state, ZIP code)
s the property in question:
❑'Real Property � Mobile Home (IC G1.1-�
Does applipnt own property in any other If yes, what county? I What Taxing District? Has this dedudion been requested on
county in Indiana? property for current yeaf?�] Yes� No
Deduction approved in the amount of:
2�� G_�� 20
�� � �S �-
COUNTY AUDITOR
20 � I 20 ��
County Audilor
20 � I 20 O 7� I 20
I/ We certify under the penalry of perjury that the above and foregoing infortnation is true and corred and that lhe applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
of appfic�l �;� � �Address of authorized person