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.•�—n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
��i�FOR DEDUCTION FROM ASSESSED VALUATION
Stale Form 43709 (R8 / 2L7) �
'�;, r Presaibetl by Depanment of Local Govemment Finance
�rrsrRUCnoNS: DEC q'�4N'f�Jg
To be fried in person or by mail with the CountyAuditor o/the county where fhe property is bcated. -
Fding Dates: 1 J Real Property: Durrng the 72 monfhs be/ore June 71 of the yeer the deduclion is to be eflective. `-y�� �/!�
2J Mobile Homes assessed under IC 6-1.7-7: Belween January 15 and March 2 0/ the year the deducBm is/"o b�6elfec�e�'^z
See reverse side /or additional insWCtions a� qua/ificatbns. C/ V
GIBSON COUNTY AUDITOR
Applicant(o w Va er-see e 'de)
T Dis - ` Key n mber I legal desaipGon Recortl number P ge nu ber
Clil'.c l�J • - — - ��DO- �JQ� �� ��
Assessed value of 2al propelty as ot March 1, narenl year Mortgage / Contracl i�eWedness unpaid as of March 1, Is tha appGnnllhe ade lepal w equitable wme/t
current year /� � s � _ _ _
what is his / her exact share of interesl?
�ny�9� o� �u�
Address of rtartgagee w oonUact selier (numb�� arrd sireeG dty, sfate, arM ZIP code)
/
Name of asvgnee or other owner or hdder of mortgage
Address of asvgnee
Does applicanl o.vn poperty in arry other
courriy in Indiana?
❑Yes ❑ No
Deduction appmved in the amount of:
�
sy�w�e ot
�
Ii yes, what counry7
20
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-'1 s� (O � (O�
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VJhat Te�cing DisVicl?
COUNTYAUDROR
20 _ � 20
...
Card Np . ..................
Has lhis deduclion been
fw wrtenl yeaR
�3�
�ested on property
❑ Yes ❑ No
o�a p,ronm. eay, yesr�
20
I/ We certly under the penalry of perjury that ihe abwe and foregoing infortnaGOn is hve and correct and that ihe applicants was I were a resident of
Indiana and owner of fhe aforementioned property on March 1, 20
InaWre (owners lull ne Date (rtronfh. day yean
ola'�� nCtS(num6erantl ef.cdy,� te
, V J /�!f ,//�.
duty exewted Power of Ntomey a Dy IC
Addiess of aulhor¢ed person
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