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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stele Fwm 43709 (R6 / 5-06)
Presvibed by Depanment of Laal Govemment Financa
Coun Township Year
INSTRUCTIONS: File Mark
To be filed in person oi by mail with the County Audito� of the county where the p�operty is located. MA i 1 4 2���
Filing Dates: i) Real Property: During the 12 months before June �7 0/ fhe yea� the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea��educt{'qn�s to be ef%ctive.
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See �everse side for additional instnictions and qual�cations. �l G
GIBSON COUNTY AUDITOR
Applirant (owne� or cont2cf �uyer - see stnctions on reve�se side) / / �
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Taxing District Key number I legal description Record number
a 6 - °� °2 '�8 �/Oo -00/ • /oY ` Page number � g
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ssessed value of real property as of Mortgage / Contract indebtedness unpaid as oi Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? � Yes � No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that ot applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mod1e Home (IC 61.1-7)
�e of mortgagee or contract seller �/�
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Address of mortgagee or contract seller (number and s6eet, city, state, ZIP
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Name of assignee or other owner or holder oT mortgage
Address oi assignee (number and ;� S-�`i • 0 �
a"�'c�ita" �dp? 3�IL� _ >7
Does applipnt own property in any �% �+ Jistriet? �Has this deduction been requested on
county in Indiana? �► "`C'��'�'�' �' property tor current year? Q YesO No
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Deduction approved in the amount of:
20 � 20 _g� 20 � 20 20 20 20
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Signature Counry Auditor Date
��� We certity under the penalty of perjury that the above and foregoing infortnation is We and cortect and that the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
S�qnature ne/s full name) � Person authorized by duly executed Power oi Attomey
j; or by IC 6-1.'1-12-.07
ull resident ad ress oi applicant Address of authorized person
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