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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (RS / 4-03)
Piescribed by Oepartmem of Local Govemment Financa
Coun Township Year
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor o( the county where the property is located. � � Z���
Filing Dates: 1) Real Property: During the 12 months before May 11 ot the year the deduction is to 6e e/lectiveB 2
2) Mobile Homes assessed under IC 6-1.1-7: Belween January 15 and March 2 0) the year the� -dyeyd�uc�tio� �be ef/ective.
See reverse side (or additional instructions and qualifications. l'' � Q
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� . GIBSON COUNTY AUDITOR
(owne� or contract buyqF- �ee restnctions on
Taxing Dislrid
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Assessed value oi real property as of
March t, cunent year
Key num rYTegal descri n� Rewrd num
a�-L�- s-yo -�,b�9a
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Mortgage / Conlract indebtedness unpaid as of Is the a
March 1, current year �Cl �(p����{.� owner?
ao,ovv
Ii no, what is his / her exact share of inlerest? —%
If name on record is different lhan that of appiiwnt, indicate below:
mortgagee or contrect seiler
Address of moRgagee or wntrect seller (number and st2et, city,
Name of assignee or other owner or holder oi mortga`ge
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t the sole legal or equitable
� Yes ❑ No
If owned with someone otner fhan spouse, indicate with whom.
Address of assignee (num6er and sfreef, city, state, ZfP code)
Does applicant own property in any other If yes. �h��— - �
county in Indiana? • A`'�
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�07-� �Y+-��i
Deduction
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Signature
the amount c �� � � � ���
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County Auditor
20
Is the property in question:
❑ Real PropeAy ❑ Mobile Home (IC 61.
�istrid? Has this deduc[ion been requested on
property for current yeaR � Yes ❑ No
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Date
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�We certify under the penalty of peryury that the above and foregoing information is tme and correct and that the applicants was / were
resident of Indiana and owner of the aforementio�ed property on March 1, 20
full
Person authorized by duly executed Power
or by IC 6-1.1-12-.07
authorized person