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STATEMENT OF MORTGAGE OR CONTRACT IIvDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R6 ! 5-06) �
Presaibed by Deparimenl of Lopl Govemment Finance
INSTRUCTIONS:
To be (led in person or by mail with the CountyAuditor of the county where the p�operty is located. 1,�I 4 Z���
Filing Dates: 1) Rea/ Properiy: Dunng the 12 months before June I i o/ the yea� the deductlon is to be �A2Ltive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maroh 2 of the year the deduction is to be effective.
See reverse srde for additional instructions and qualifications. �� 'a�
GIBSON COUNTY AUDITOR
Applicant (owner or contract buyer- see restridions on re rse side) .
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Tauing Di t' � Key number / legal description Record number •
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d 6-/a -o �_ a0 /-ao a. �� y..�, Pag� number �� �
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 7, curtent year March 1, curtent year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? - If owned with someone other than spouse, indicate with whom.
If name on record is diiferent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
e of mortgagee or contract seller
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Addresa of moAgagee or contract seller (number and stieet, c,`state, ZIP
Name of asaignee or other owner or holder of mortgage
Addres� of assignee (number and sbeet, city, state, ZIP code)
Ooes appficant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amounl of:
20 �� 20 �� 20 20 20 20 20
P P
Signalure County Auditor Dafe
We ceA'rfy under the penalty of perjury that lhe above and foregoing information is true and corred and ihat the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners /ull name) Person authorized by duly executed Power of Attomey
� Q or by IC 6-1.1-12-.07
ull res' nt address of applicant Address of aulhorized person
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