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� ". STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1\,�� FOR DEDUCTION FROM ASSESSEDyALUATION\
`�: .% SUte Form 43709 (R6/5-06) °`': :�� �i.• � ".` . ; "' : %�:• %-�. .�. � 1^ " .
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�� Prespibed by Department of Loqi Govemmenl Finance �—'
INSTRUCTIONS:
To be filed in pe�son o� 6y mail wrth the County Auditor of the county whe�e the propeRy is located. �
Filing Dates: 1) Real Property: DuAng the 12 months be(ore June �l of the year the deduction is to be ��iiv� '] 2���
2) Mobiie Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 o/the year lhe deducG'on is to 6e eliective.
See �everse side fo� additional instnictlons and qualifrcations. � �
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GIBSON COUr+� � ���'."'�
pplicant (owner or contract buyer- see restrictions on reverse sid )
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Taxing istrid Key number / legal description Record number
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Page number �
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Assessed value of real prope as of Mortgage / ContreG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? �es � No
I o � a ,----� -
Ii no, what is his?/ her exad share of interest? If owned with someone other than spause, indicate with whom.`; `
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If name on record is different than that of applicant, indicale below: ' -yIs tr�-e� perty in q estion:
��� O`aeai Pro�y ❑ Mobiie Home pC 61.1-�
�me of mortgagee or contrad selle:
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Address of moRgagee or tract seller (number and st2et, city, state, ZIP "• � !' '�
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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 counry? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? ' property for wnent yea(?� Yes� No
COUNTY AUDITOR �
Deduction approved in the amount of: _.+�"
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20 O�' 20 d 20 20 20 20 20
P
Signature County Auditor Date
�� We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned propeRy on March 1, 20
Signature (owners /ull name) Person authorized by duly executed Power of Attomey
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Full resident address of applicant Address of authorized person
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