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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSED VALUATION
t / State Fortn 43709 (R4 ! 10-01)
w.
� Presaibe0 by DepaNrent ot Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 montAs beJore May 11 of the year lhe deduction is to be ��ti�.$ 2��3
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year the deduction is to be eHective.
See reverse side Ior additional insGuctions and qualifica6ons.
J
GIBSON COU 7Y SUDITOft
buyer
,ed value of real property as of
1, current year
If no, what is his / her exad share of interest?
on 2ve�se side)
Key r�Gfnber / legal description Record number
� � � � �-0Q Page number /�� /
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunenl year owneR ❑ Yes ❑ No
/ D� �
If name on record is different ihan that of applicanl, indicate below:
mortgagee or contrad seller
If owned wilh someone ather than spouse, indicate with whom.
Is the property in question:
� Real Property ❑ Mobile Home QC 61.1-�
Address of mortgagee or conVact seller (number and street, city,'state, ZIP — .—� —
Name of assignee or other owner or holder of mortgage D a�� 1� �•""�'� ��������
1 �ta�........
Address of assignee (number and street, city, state, ZIP code) ••••"' ��
Card N •••
� Ic�.�•
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent year? � Yes ❑ No
Deduction approved in the amount
20
Signature
COUNTY AUDITOR
��G��JL��
County Auditor
20 �( 7
�
20 �� 20 D
�
Date
' We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that lhe applicants was / were
resideni of Indiana and owner of the aforemenlioned property on March 1, 20
full name)
l�
or by IC 6-1.1-12-.07
resident add ess of applicant � Address of authorized person
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