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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. / State Form 43709 (RS / a-03) _ � , • � . ,
� �
PrescnDed by Department of Loral Govemment Pinance
INS7RUCTIONS: MAY O ��LQ�E�
To be filed in person or 6y mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ the year the deduciion is to 6e effective. v
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yeaGt�re���ctf6�s to be eHective.
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See reverse side lor additional instiuctions and qualiTcations. GIBSON COUNTY AUDITOR
Ap i ( wnerorcon t 6uyer- ee ctionsori revers �
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Taxi DislriIX Key number / legal description ewrd number
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/1/} �� �.1� _ Page number � � � /
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Ass sed value of real property as of MoAgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March t, current year � . owner? ❑ Yes ❑ No
/ �� . '
it no, what is his / her exaa share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan thaf of applicanl, indicate below: Is the property in question:
mortgagee or conlract seller
of mortgagee or contred seller (number and stieet,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
state, ZIP
❑ Real PropeAy ❑ Mobile Home QC Crt.t-�
_ ..�-_
- DYB�'Cr� s'•� / .�.I
10
Cara ��
Does applicant own propeRy in any other I If yes, what county? What l
county in Indiana?
20 �'[_
Signature
�U _ p? COUNTY AUDITOR
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in lhe amount of:
20 0 D 20 _� 20 20
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County Auditor
20
Date
requested on
_ _. .' C� Yes � No
20
We certiry under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed
or by IC 6-1.1-12-.07
of authorized person