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,��} STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
���` FOR DEDUCTION FROM ASSESSED VALUATION
� Siste Fortn 43709 (R615-061 '
� Presaibed by Oepartment of Lonl Govemment Finance
'�.
INSTRUCTIONS: �
To be filed in person o� by mail with the County Auditor o/ the county whe�e the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before Jone I1 0/ the year the deduction is q� j� �f�tip��]
2J Mobile Homes assessed unde� lC 6-1.1-7: Between January 15 and March 2 of t7�e year the deduction is to be eliective.
See reverse side fo� additional instructions and quali(ications. �/j� ,Q �
_ GIBSON COUNTY AUDITOR -
Applicanl (owne� or
Taxing Distrid
Assessed value of real
March 1, current year
as of
no, what is his / her exad share of interesl?
„o ............ ..:�e�
Key number / legal aescription � � Record number
o�'w "7VV'C/CJV' {� ' .
Mortgage / Contrad indebtedness unpaid as of Is the a�
March 1, current year owner?
6
t the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is different lhan lhat of applicant, indicate betow:
�me of mortgagee or contrad seller I����
Address of mortgagee or contrad seller (number nd street ity, state, ZIP
Name of assignee or other owner or holder of mortgage
Address ot assignee (number and street, city, state, ZIP code)
Does applicant own propeRy in any other If yes, what county?
county in Indiana?
Dedudion approved in the amount of:
20�� 20 20
P
Signature
What Taxing Distnd?
COUNTY AUDITOR
20
County Auditor
20
Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
Has this deduction been requested on
property for curtent year? � Yes ❑ No
20
Date
20
We certify under tne penalty of perjury that the above and foregoing information is true and correcl and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
� e(ow rs 1 a e� Person authorized by duly executed Power of Attomey
or by IC 6-1 J-12-.07
�jl r en address pli t n, Address of authorized person