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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 43709 (R6l S-06) -
Presaibed by Department of �ocal Govemment Finarxe
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Count Township Year
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INSTRUCTIONS: MAR �i���}Q$
To be (iled in person or by mail with the County Audito� of the county where lhe p�operty is located.
Filing Dates: 1) Real Property_ Dunng the 72 months before ,lune Il of the year the deduction is to be e/iec '
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 o(the year th��d���is be elfective.
GIBSON COUNTY AUDITOR
See reverse side foi additional instnictions and qualifications.
Applicant (ownerorcontract buyer- see restrictions on �repverse s
S C tl� 11 �`� \ 1 1�11 i Q �`l. �
Key number / legal description
a t�- i s-3 �-aca-cm a. i
Assessed value of real property as of Mortgage / Contrad ir
March 1, curtent year March 1, current year
Recon �mbea� �^/ ,
'Of'! Page num. � n —
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as of Is the a� e sole �� yuitable
ownef: �j _c � No
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
� Real Property ❑ Mobile Home pC 61.1-�
e of mortgagee or con ad seller ,.,{�
\25L,f1n ���IiSiUS(1L?1'ltam'l�Dh 2.�n./�
Address of mortgagee or contraG seller (number an treet, ty, sfate, ZIP
Name ot assignee or other owner or holder of mortgage
(num6erand st2et, city, sfate, ZlPcode)
Does applicant own property in any other I If yes, what county? VYhat Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? property for wrrent year?Q Yes❑ No
Deduction approved in the amount of:
20 �� 20 20
P
Signature
COUNTY AUDITOR
20
County Auditor
20
20
Date
3�]
ceAify under the penalty of perjury that the above and foregoing information is true and corred and lhat ihe applicants was / were
lent of Indiana and owner of the aforementioned propeAy on March 1, 20
(owners /ull
applipnt
Person authorized b�
��'U$ or by IC 6-1.1-12-.07
Address of
person
of Attomey