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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Siata Form 43709 (RS / 4-03)
P2sfnDeE by Department ol Local Gtivemment Finance
Coun Township Year
�NSrRUCnoNS: FEB 1 � ��a�x
To be filed in person or by mail with the County Auditor of the county where the propeRy is located.
Filing Dates: 1J Real Property: During the -12 mon[hs 6e/ore May 11 oI the year the deduction is to 6e eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year`�d�ed�t r-is to 6e elfective.
See reverse side for additional insWctions and quali(cations. G�BSoN COUNTY AUD�TOk
fed value of real property as of
1�, current year
on reve�se
Key number / legal description {/ � Record number
DO/ 1^ oD Q' C-j5' ,ey� Page number ^�
`7 O �I C/ (�CJ ' /
Mortgage / Contract indebtedness unpaid as of is the applicant the sole legal or equitable
March 1, current.year owneR ❑ Yes ❑ No
1 ��, � �
If no, what is his / her exact share of interest? If owned with someone olher than spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
� � ❑ Real Property ❑ Mobile Home QC 61.1-�
�me of mortgagee or contract seller ,
513
Address of mortgagee or conVad seller (number an�street, city, state, ZIP
Name ot assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Ooes applicant own propeRy in any other If yes, what counry?
county in Indiana?
Deduction approved in the amount of:
20 �_ 20 _(J � 20 b'
P �' �
Signature
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What Taxing District? Has this deduction been requested on
property for wrrent yea� � YesO No
COUNTY AUDITOR
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County Audifor
20
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20
(y under the penalty of perjury that the above and foregoing information is true and correct and that ihe applicants was / were
of Indiana and owner of the aforementioned propeRy on March 1, 20
name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person