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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
�. � J SWte Form 43709 (R5 / <�3)
� P2scnEed by Department of Local Govemment Finance
Coun Township Year
INSTRUCTIONS: M�Y File t�p{�
To 6e filed in person or by mail with the CountyAuditor of the county where the property is located. d LUU�
Filing Dates: 1J Real Property: During the 12 months before May 11 of the year the deduction is to be eHective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year th�",Q'�ct�g��p 6e eHective.
See reverse side !or additional instructions and qualifications. GIBSON COUNTY A DITOR
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(owner or contract buyer - see
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Taxing
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Assessed value of real property as of
March i, current year
If no, what is his / her exacl share o( interest?
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on reverse side)
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Key number / legal description Record number r�/'
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Mortgage / ContraG indebtedness unpaid as of Is the applicani the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
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� If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contract seller
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Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(number and street, cify, state, ZIP code)
Does applicant own property in any other i�� � � vhat county? I What Taxing District?
county in Indiana?� -
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Drawer NO• C/�" /.......
CardN�• •• • ........ ......
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Signature
COUNTY AUDITOR
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County Auditor
s Ihe property
❑ Real Property ❑ Mobile Home (IC Fr1.
Has this deduction been requested on
property for current year?� Yes� No
�
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20 .
(owners lull name)
address of applicant
I r'�, x 3
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
authorized person