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��y ,� STATEMENT OF MORTGAGE OR CONTRACY INDEBTEDNESS
'i' � FOR DEDUCTION FROM ASSESSED VALUATION
y State Form 43709 (R6 / 5-06)
�� Presaibed by Department of Loral Govemmem Finarice I
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INSTRUCTIONS: JULFiIq Madc„07
To be filed in pe�son or by mail wrth the County Audifo� of the county where the property is loca[ed. V b LU
Filing Dates: i) Real Property: During the 12 months befo2 ,lune 11 of the year the deduction is to be eftectiv .
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2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the year the d i��eflective.
See reverse side for additional insWcUons and qualificatrons. i GIBSON COUNTY AUDITOR
Taxing
or canfract buyer - see
ed value of real property as of
1, curcent year
If no, what is his / her exad share of interesl?
If name on record is different than that
reverse side) !
Key number / legal de:
� 6(o-D�Q
� � —�� �•$ ` Page number
Mo gage / Conlrad indebtedness unpaid as of Is the applican�sole legal or equitable
March 1, currenl year � ownef? es ❑ No
�DOb
If owned with someone other than spouse, indicate with whom.
mortgagee or contrad seller � �
:� � :U ,. .
01 mortgagee ar conVad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
county in Indiana?
Deduction approved in the amount of:
20 � I 20
Signature _
cou
Is the property in question:
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.......
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C:ll'Ci ti0. ..�..�'�' �/.....
� IyO,Q'�
20 20 20
County Auditor
20
Date
� Mobile Hortie (IC G1.1-�
i .
`i en requested on
� af?� Yes❑ No
:�
20
We certiy under the penalry of peryury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March t, 20
name)
�� I Person authorized by duly executed Power of Attomey
; or by IC 6-1.1-12-.07
of applicant , j �Address of authorized person