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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
's �� / Stata Fwrt: 43709 (RS / 4-03)
�«
� Presaibetl Ey Department of Local G6vemmem Finance
INSTRUCTIONS: O C�T11eI"�'�2003
To 6e filed in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months 6efore May 11 of the year fhe deduction is to be e t�ve.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the yea e ded '��s be eff�'tiv
See reverse side foi additional instructions and quali�catie� GIBSON COU T 1' AUDITOR
7axing D' rid �
(i�,�""'° "
A essed value of real property as of
March 1, current year
If no, what is his / her exact share of interesl?
If name on
that
or contrad seller
Address of moAgao� '
;
� Q3,�y7%
n� Dra"er N�".
ooE Cara��' .
coun
Deduction approved in the amount of:
20 C/ �1 I 20
on
Key number / legal description Rewrd number ��
M� OO��� �� Page number (��/ 3�
Ci(J Q To7
Mortgage / Contrad indebledness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef7 ❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
and street, city,
�age
:ounty? � What Taxing Distric[?
COUNTY AUDITOR
20 �i,_ 20 0% 20 D
/
County Auditor
s the property in question:
O Real Property ❑ Mobile Home (IC Cr1.1-�
Has this dedudion been requested on
property for current yeaf? � Yes ❑ No
20 �_ I 20
/ We certify under the penaity of peryury that the above and foregoing infortnation is true and coned and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
resident address of applica
�. �. � 3 �� 3
�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address ofauthorized person