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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FQR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
z• � ! State Form 43709 (RS / a�3)
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� PmSaiDeE Dy Department o; Loral Govemment Finance
INSTRUCTIONS: � � e M rk
To be �led in person or by mail with the County Auditor of the county where the property is cate� �
Filing Dates: 1) Real Property: Dunng the 12 months before May 17 0! the year the deduct' is to e eflective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the,�Gar tt�e�e��f'rpn is to be effective.
JUL
See 2verse side Jor additional instruc(ions and qualifications.
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Applicant (owne� r don cf b�yer - see
Taxin Distrid
Q�
Assessed value of real property as of
March 1, current year
If no, what is his / her exacl snare of
reverse
number
GIBSON
Record number ^�
v
O/ 2�0��� / Page number � '1 ��
✓ O�
MoAgage / ConlraU indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
�v�5�9. Sa
If owned with someone other than spouse, indicate with whom.
I
If name on record is different than that of applicant, indicate below:
'.me of mortgagee or contract seller
S 3
Address of mortgagee or contred selier (number and st2 , city, state, ZIP
Name ot assignee or other owner or holder o( morigage
�
[..7
Full
0
� S-� 4� � 7 �'
it Taxing Distrid?
�ITOR
20
property in ques�ion:
❑ Real Property ❑ Mobile Horr�e (IC 61.1-�
Has this deduction been requested on
propeAy for current year?0 Yes� No
20
Date
20
information is true and corred and that the applicants was / were
�'ch 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.7-12-.07
ofauthorized person