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STATEMENT OF MORTGAGE OR CONTRAGT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of jax Commissioners
Instructions for filing:
To be filed in persori or by mail with the County Auditor of the county where the
property is tocated during the 12 months before May 11 of the year the deduction.
is to be effective. See reverse for additional instructions and qualifications.
Applicant
Taxing
or contract
Assessed value of real property as
of March t, current year
Key
as of
If no, what is hislher exact share or interest?
on
D�C O l 1999
!
GIBSON G�7! �� TY P.UDITOR
Description � Record No
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Page No. �� � 1 �
�ntract Indebtedness unpaid Is the applicant the sole legal or
1, currentyear. equitable owner? O yes �7 no
If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contract seller
of mortgagee or contract seller
Name of Assignee or
of Assignee
owner or holder
age.
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Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes J no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Signature
Og-�
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_ Secretary of
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of Review ! Date
is 6E o7
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I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�n�wners� II narpe) /� Person authorized by duly executed Power of Attorney or
,�,/� / .- �, •' „ by IC 6-1.1-12-.07).
of Aplicant , , . , � Address of Authorized Person