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/e� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`+�`'���$��i' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
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`•,�yJ State Form 43709 (R6 / SO6)
� Presaibed by Depanmen� of Lotal Govemment Finarice
INSTRUCTIONS: .JUN 1 �1e?,��7�
To be tiled in person or by mail with the CountyAudito� of the county where the p�operty is located.
Filing Dates: i) Real Property: Dunng the 12 months before ,lune � 1 0l the year the deduction is to be e�g� ,Q
2) Mobife Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of theGiBSON COUNTIP �}�f��ective.
See �everse side for additional instrucfions and quali�cations.
Applicant ( er or contracf buyer- see resfrictions on ieverse� i e)
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Taxing Dist Key number / legal description Record number � y�
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!� ^ . / _ ' • ��� 9e number sa6
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Assessed value of reat property as of MoAgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, currenl year ownef? ❑ Yes ❑ No
50 �
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
� Real Properly ❑ Mobile Home (IC G1.1-�
me of mortgagee or contracl seller � `
Address of moRgagee or contrad seller (number and streef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sUeet, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty? What Taxing Dislrid? Has this deduc[ion been requested on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
zo � zo � Zo � 9 zo zo zo zo
P F �
Signature County Auditor Date
�We certify under the penalty of peryury that the above and foregoing informalion is true and corred and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature owners full name) Person authorized by duly executed Power of Attomey
• or by IC 6-1.1-72-.07
Full re ident address of applicant Address of authorized person �