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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (RS I 4-03) `1
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Prescribed by Departmeni of Local Govemment Finance ��� i� i
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INSTRUCTIONS: ,JUL � $ ZO�e Mark
To 6e filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 01 the year the deduction is to 6e eBective� n
2J Mobile Homes assessed under IC 6-1 J-7: Setween January 15 and March Z o/ the year the d�uction�s lo'be effective.
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See reverse side for additional instructions and quali�cations. �� GIBSON COU��-Y AUD�70R �
Applicant (owneror tract buyer- see restri ns on v e side)�
Taxing Distrid Key number / legal descrip[ion R rd num er O�
� ^ �_ /y� f %, O� / ^ _ 0� Page number Lf -7��
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Assess value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
��(0300
ii no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan lnat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
"ame of mortgagee or contrad seller � �
Address of mortgagee or contracl seller (number and street, ity, state, ZIP
Name of assignee or other owner or holder of mortgage
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Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? properly for wrrent yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
/
20 20 20 ��a 20 � 20 f1� 20 � 20
P P � P
SignaWre County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is irue and corred and that the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
��;ignature (ownels full name) Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
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ull res ent a dress of applicant Address of authorized person
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