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�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
'' ' FOR DEDUCTION FROM ASSESSED VALUATION
�+� � ! State Fartn 43709 (R6 / SO6) � � � � n
Presaibed by Depanmem of Laal Gwemmem Finarxa ' �
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INSTRUCTIONS: MAR f�eQa�,Q07
To be frled in person or by mail with the County Auditor of the county whe�e the prope�ty is located.
Filing Dates: 1) Real Property: Dunng the 12 months belora June I f of the year the deduction is fo be eHec �" ,��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year thekfeii ' n i"s��Jbe etlective.
See reverse side for additional instructions and qualffications. GIBSON COUNTY AUDITOR
Applicant (owner contract buyer - see res 'ctions o reve�se side)
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Taxing DisGi y number / legal description Record number
( %/ �Q ^ � • / '// a,L /Oo,��///J �� Page number
7�- W �o T- roa-
Assessed value of real property as of Mortgage l ConUad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curtent year owner? � Yes � No.
- v, �
if no, what is his / her exact share of interest? If owned with someone other than spause, indicate with whom.
Ii name on record is difterent than that of applicant, indicate below: Is the property in questio�:
❑ Real Property � Mobile Home QC 6-1.1-�
Name oi mortgagee or contract seller ��
Address of mortgagee or contract selier (number nd st�eet, crty, slate, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applipnt own property in any other Ii yes, what counly? What Taxing District? Has this deduction been requested on
wunty in Indiana? property for curtent year? ❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20�� 20 � 20 20 20 20 20
P
Signature County Auditor Date
I/ We certiiy under the penalty of perjury that the above and foregoing informa6on is true and cortect and that the applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20
.ature ( wne/s full name) ./ Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
Fu I resident address of applicant Address of authorized person
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