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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R5 / 4-03)
PrescriCetl by Oepartmem of local Govemment Finance
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INSTRUCTIONS: U l, I Fil� Mar��3
To be filed in person or by mail with the CountyAuditor ol the county where the property is located.
Filing Dafes: 1) Real Property: During the 12 mon[hs before May 17 0l !he year fhe deducfion is to 6e efFective. �
2) Mobile Homes assessed under IC 6-1J-7: Between January 15 and March 2 olthe yeartbe.d�pys�abe���Ye.
See 2verse side for additional instructions and quali�cafions. �O GIBSON C�?UNTV AUDITOR (
Applicant (o�r or contract
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Taxing District
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see restrictions on
value of real property as of
March 1, curtent year
Key number / legal description I Record number
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OO �/_�v� 5O _� I Page number
Mortgage / Contracl indebtedness
March 1, curtent year
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If no, what is his / her exact share of interest?
If name on record is diNerent than that of applicant,
of mortgagee or contract seller
as
Is the applicani the sole legal or equitable
owner? ��es� � No
If owned with someone other than spouse, indicate with whom.
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Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other ovmer or holder of mortgage
Address of assignee (number and street, ciry, state,
i�roperry in question:
Real Property ❑ Mobile Home pC E1.
Does applicant own property in any other If yes, what county? What Taxing Dislrict? Has this deduction been requested on
county in Indiana? property for curtent year? 0 Yes ❑ No
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Signature
COUNTY AUDITOR
approved in the amount
20 � I 20 ��-,L � 20
Counry Auditor
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We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
full name)
Person aulhorized by duly executed Power of Attomey
or by IC E1.1-12-.07
of authorized person