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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S�ete Form 43709 (R6 / 5-06)
Presaibad by DepeMtent of Local Gavemment Finance
INSTRUCTIONS:
To be filed in person or by mail with fhe County Auditor o/ the county where the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months before June 11 0/ the year the deduction is to be eff��. 1 3 Z��]
2) Mo6ile Homes assessed under lC 6-1.1-7: Be[ween January 15 and March 2 0/ the year the deduc6on is to be el%ctive.
See reverse side fo� additional instructions and qualifications. �jaO ,Q�
GIBSON COUNTY AUDITOR
or contract buyer - see
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Assessed value of real property as of
March 1, current year
no,
name on
exact
on reverse side)
Key numb�(/ legal description
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MoRgage / ConVact indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year owner? � Yes � No
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If owned with someone other than spouse, indicate with whom.
�^ie o`f��ortg�ag�ee or cantract seller
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Address of mortgagee or conVact seller (number and street, city, state, ZIP
�T assignee or other owner or
s of assignee (numbe�and si
ppliqnt own property in any c
in Indiana?
ion approved in the am0unt c
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mortgage
If yes, what counry?
❑ Real
IiC/M1-C.0 ��
Taxing Distr ;
COUNTY AUDITOR
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Counry Auditor
❑ Modle Home pC Cr1.
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I/ We certify under the penalty of perjury that the above and foregoing informatlon is true and conect and that the applicants was / were
�:sident oi Indiana and owner of the aforementioned property on March 1, 20
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person