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ii%'-' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`i•�i= FOR DEDUCTION FROM ASSESSED VALUATION , . Count Township Year
: _�+ State Fwm 43709 (R6 / 5-06) . . � � � �
Prescribed by Depertment of Lwal Govemment Finance -
�
INSTRUCTIONS: �{j��� Z00%
To be �led in person o� by mail with the County Auditor ot lhe counfy where the p�operty is located.
Filing Dates:� 1J Real P�operty: Dunng the 12 months befoie ,lune 17 of the year the deduction is to be effective. �p-�y�,r,a�. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ fhe yea� the deduc� 6on ,�fo be�ectiv .
See reverse side for additional instructions and qualifications.
GiBSON COUNTY AUDITO�Fi
contract 6uyer - see resMcticlnspn rever5e side)
Assessed value of real property as of
March 1, current year
If no, what is his / her exact
Key number /�al desuiption I Record number
MoAgage / Contrac[ ir
March 1, current year
name on record is different than ihat of applicant,
of mortgagee or contrad seller
of mortgagee or contracl seller
Page number
unpaid as of Is the applicant the sole legal or
ownef? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
' , ' �
and st2et, c, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and stre�
Does applipnt own property in any oth
county in Indiana?
Drawer NO,a�i�10�.: �.�.�.�G
C C(� �'�. '
�� � fe,ti•'�.i. � 8� �G10 . o 0
-- —� J
Deduction approved in the amount of:
20 �_ 20 O9 20
P �
Signature
We
COUNTY AUDITOR
20
County Auditor
20
Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1
Has this deduction been requested on
property for curtent yea(? � Yes ❑ No
20
Date
20
under the penalty of perjury that the above and foregoing informalion is lrue and corred and thal the applicants was / were
Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-t.t-12-.07
of authorized person