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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
!+ State Fwm 43709 (R6 f 5-06)
� Presaibed by Depenment of local Govemment Finance
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INSTRUCTIONS: File Mark
To be (led in person or by mail with the County Auditor of fhe county where the property is located. iV�Ai 1$ Z��]
Filing Dates: 1) Real Property: During the 12 months 6efore June 11 of the year the deduction is to be eflec6ve.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 2 0l the year the-deduc6or� is-to be elfective.
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See reverse side for additional insfructions and qualifications. �/ �
GIBSON COUNTY AUDITOR
Assessed value of real
March 1, current year
If no, what is his / her exact
a�-ia-�g- ��
If name on record is difterer
�
�'
� _ Page number �o a3
as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year " owner? ❑ Yes � No
�i�804D
��e oi mortgagee or wntract sellP•—' O. �D J��
� Q.�•t'••.
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Address oi mortgagee or c Dra\�'C� � f „
Name oi assignee or other o'• Ca((� �� •'' .
Address oi assignee (number; ,'�� ,`.are, ZIP code)
Does applicant own
wunry in Indiana?
20 h"1
\
Signature
20 �
someone other than spouse, indicate with wFwm.
any other � Ii yes, what county? � What Taxing District?
COUNTY AUDITOR
20� 20 20
��
County Auditor
s the properly in question:
❑ Real Property � Motnle Home QC G1.
Has this deducfion been requested on
property for current year? Q YesO No
.+��
Date
20
I/ We certify under the penalty of peryury that the above and foregoing infortnation is We and conect and that the applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20
.,.-yn mre �owners �uu
�
Fu reside ddress c
S.
or by IC 6-t.t-12-.07
authorized person