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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R6 / SW)
Presvibed by Depanmem of Local Govemmenl Finance
NOV
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INSTRUCTIONS: G�BSON COUNTYF�j,���"
To be (i/ed in person or by mail with the County Audito� of the county whe�e the property is located.
Filing Dales: 1J Real Property: During the 12 months before ,lune 11 0/ the yea� the deduction is to be ef(ective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side for additional rnstructions and qualfications.
Applicant (owner or contracf uyer - see restrictions on reverse side)
Ta�cing Distrid Key number / legal description Rewrd number
G � �9-/o/-!X�• 34� oa 7 �%��
� � Page number 7 , h
oi� - �3 7-� �i , <oU
Assessed value of real property as of Mortgage / Contrad indebtedn s unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year owneR ❑ Yes ❑ No
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If.no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan ihat of applicant, indicate below: Is the property in question:
Property ❑ Mobite Home QC 61.1-�
me of mortgagee or contrad seller
Address of mortgagee or conVact seller (number nd street, city, state, ZIP /-
Name of assignee or other owner or holder of mortgage _ — �, .•••
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Address of assignee (numberand street, city, state, ZIP code) �� ���'�Y /� im.�•
o. ���..
Does appliwnt own property in any other If yes, what county? What'� C,�� (� � 1 _., �equested on
county in Indiana? _„� rent yeaR � Yes ❑ No
COUNTY AUDITOR _v
Dedudion approved in the amount of:
20 �� 20 Q 20 �� 20 20 20 20
1 1 `
Signature County Auditor Date
�We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicanls was / were
resident of Indiana and owner of the aforementioned property on March 7, 20
S n ture owners full na ) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07 �
F II resident address o applicant Address of authorized person