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/ei � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
I`i '" . FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
`• � State Fwm 43709 (R6 / 5-06) . . . , , � �
� Presaibed by Department of Local Gwemment Finance
INSTRUCTIONS: � E LF'�� ��OO %
To be �led in person or 6y mail wrth the County Auditor of the county where the propert,v, is located. � •
Filing Dates: i) Rea/ Property: Dunng the 12 months before June I f of the yea� the deduction is to be effectiv . /�y�
2J Mobile Homes assessed unde� IC 6-1 J-7: Between January 15 and March 2 0/ the year the d�� !S'ldYS� effective.
See reverse side for additional instnictions and qualificalions. GIBSON COUNTY UDITOR
or contract buyer - see
Taxing Distrid
on reverse side)
�J �-
Key number / legal description (/ Record nurtiber �•OO 7
` //L2 ` o� ��O - O'S - yl�� - / O % - 00.3�' Page number
7.z �r ,c. 7 a. �- o� 7 �o a s`�
Assessed value of real property as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year March 1, wrrent year owne(? ❑ Yes ❑ No
77� S9�f.�f�
If no, what is his / her exacl share of
If name on record is different ihan that ot appticant,
If owned with someone olher lhan spouse, indicale with whom:
Is the propeRy in
❑ Real Properly ❑ Mobile Home (IC 61.
e of mortgagee or contract seller � . �
�i . . ! !.� 4 � . .
Address of mortgagee or conVact selier (numberfand stieet, city, state, ZIP , . -
Name of assignee or
Address
owner or holder of mortgage
(number and street, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
)eduction approved in lhe amount of:
20� 20�� 20
P P
Dra�ver NO.�(�Q�:. �o�W�
�� 31' �1%� ;�/�,�jj�} p�
What T;' �"'�G���%uc��/ �i/�S• ` 77� p 7�! ��.ed on
� property for wrrent year! u res 0 No
COUNTY AUDITOR
20
County Auditor
�
20
Date
20
certify under the penalty of perjury thal the above and foregoing information is true and corred and lhal the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly execuled Power of
or by IC 6-1.1-12-.07
LII resident address of 2pplicant �--- Address of authorized person
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