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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
SUte Form 43709 (R6 / 5-06) �
Presaibetl by Depertmenl of �oql Govemmeni Finance
Coun Township Year
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- 1
INSTRUCTIONS: .JUN OF�e2007
To be filed in person or 6y mail with the County Auditor o( the county whe�e the p�opeRy is located.
Filing Dates: i) Real Property: Dunng the 12 months betore ,lune 17 0l the yea� the deduction is to be effeclive. .
2) Mobile Homes assessed under IC 6-1.1J: Between January 15 and March 2 of the year i��,d�duc�trt�;i�to be effective.
See reverse side fo� additional instructions and quali/rcations. GIBSON COUNTY DITOR
Applicant wnerorcontractbuyer-seerestricti sonrever side)
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Taxing Distrid number / legal des ption Record number ���
' � -7 �.33�-Ob? Page number p��
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Assessed value of real prope as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, currenl year 1� 5� �� � owne(? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone olher lhan spouse, indicate with whom.
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I( name on record is different ihan that of applicant, indicate below: Is the property in question:
❑ Real Property O Mobile Home pC &1.1-�
�m mortgagee or contrad sell
Address of moAgagee or contrad seller (number and s t, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eef, city, state, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing Disirid? Has this dedudion been requested on
county in Indiana? property for wrrent yeaf? �] Yes ❑ No
COUNTY AUDITOR
Deduction approved in tne amount of:
20 rl 20 20 20 20 20 20
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Signature County Auditor Date
r `� We certity under the penaity of perjury that the above and foregoing information is We and correct and that the applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ulf name) � Person authorized by duly executed Power of Atlomey
� � or by IC 6-1.1-12-.07
u esiden address of applicant Address of aulhorized person