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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stale Form 43709 (R4l 70.01)
PreSCnbeO by Department ol Local Govemment Finance
Count Township Year
� DULY E TERED fOR TA? ATION
Sub'ect to mal acceptance f r transfer
day of
INSTRUCTIONS: � � � � File Mark
To be filed in person or by mail with the County Auditor ol the coun�t.y where the prope is located. G ��� n n Auditor
Filing Dafes: 1) Real Property: Dunng fhe 12 months 6efore May 1RI�h yQa jj��eduction is to �� ;; �!� �� Gibson County
2) Mobile Homes assessed under IC 6-1.1-7: B�yveen January''I �a}1H�March 31 0l th ear t e deduction is to be effective.
/. arcel �
See reverse side lor additional inst�uctrons and Quali�cafiori� /�
Applicant
Taxing
Assessed value of real
March 1, wrrent year
buye�-
" GIBSON
reverse side)
Key number /
Record
� /y�/ _ �//��/ /y� Page number �} ��
L�tO Q —C.�� �
as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
�a ���o�
If no, what is his / her exact share of interest?
If name on record is
mortgagee or contrad
Address of mortgagee or contract
lhat of applicant, indicate below:
If owned with someone other than spouse, indicate with whom.
(number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any
county in Indiana?
Deduction approved in the amount of:
Is the property in question:
❑ Real Property ❑ Mobile Hane pC &1
If yes, what county? What Taxing District? Has this deduction been requested on
property for current year? [� Yes ❑ No
COUNTY AUDITOR
20 ��, W1" 20 �� 20���� 20� 20 O�_ 20 �� 20 � J.
5 � p P
iigna re County Auditor Date
�� We certify under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
�>iden[ of Indiana and owner of the aforementioned property on March 1, 20
name)
�f applicant
3 YY f=;
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person