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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
"' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
•���� I Siate Form 43709 (RS / 4-03)
� Presci6ed by Department of Local Govemment Finance
WSTRUCTIONS: � �e�ja� � � �
To 6e filed in person or by mail with the County Auditor of fhe county whe2 the property is located. .dLJ
Filing Dates: 9) Real Property: During the 72 months be%re May 11 o/the year the deduction is fo be e/fective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the dedu�ipTis.fo qe,effeFlive.
uu U 2S CUUJ
See reverse side for additional instructions and qualifications.
Applicant (owner or
Distrid
/legal
.
GIBSON
number Q �
/� i � ,(r— vO / � O /�� O V.OQ Page number / / !\ i / / �
��.iv�� r � - v � �/ � y� l0
Assess d value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrtent year March 1�rrenot y� O� ownef? ❑ Yes ❑ No
it no, whai is his / her exac: share of interest?
if r,ame on record is different than that of applicant, indicate
'3me of moAgagee or contrad seller
Address of mortgagee or contracl seller (number and street,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 p -/
P
Signature _
20
If owned with someone other than spouse, indicale with whom.
state, ZIP
What Taxing District?
COUNTY AUDITOR
20 Oq 20 20
P
County Auditor
s the property in question:
❑ Real Properry ❑ Mobile Hane pC 61.1-�
Has this deduclion been requested�on
property for current yea(1 �] Yes � No
20
Date
20
We certity under the penairy of perjury lhat the above and foregoing informalion is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duiy executed Power of Attomey
or by IC 6-1.1-12-.07
Address ofauthorized person