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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS -�
FOR DEDUCTION FROM ASSESSED VALUATION Coun � . Township Year
S�M J Sfate Form 43709 (RS / 4-03) � y� �_ �
� PresaiDed by Depertment of Loral Govemmeni Finance � �
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INSTRUCTIONS: ��� J
To be filed in person or by mail with the County Auditor of the county whe�e the property is locate,r3. ' �, �
Filing Dates: 1 J Real Property: During the 12 months betore May 11 0/ tAe year the deduction i�e�b� eflec��p{T Y F�� ���
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of �a �e deducti � is to be eHective
See reverse side for additional instructions and qualifications. GiBSON COU1fTY AUDITOR
Applicant (own r or contrect buyer - see restncfions on reverse side)
Taxing District Key number / legal description Record number
3
O b C� — ( ^� a Page number O
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applican�sole legal or equitable
March 1, curtent year March 1, current year owner? es ❑ 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 different than lhat of applicant, indicate below: Is the property in question:
Properry ❑ Mobile Home pC E1.1-7)
"�me of mortgagee or contract seller
Addre of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty? What Taxing District? Has this deduction been requesied on
county in Indiana? property for current year? ❑ Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 D�- _ 20 o L 20 O� 20 20 �� 20 �_ 20
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Signature Counly Auditor Date
I I We certify under the penalty of perjury that the above and foregoing infortnation is true and correci and that the applicants was / were
sident ot Indiana and owner of the aforementioned property on March 7, 20
ignatu� (owne�(ull name) Person authorized by duly executed Power of Attomey
�j�� or by IC 6-1.1-72-.07
F I resident address of applicant Address of authorized person
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