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;ei� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1\ FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
`�J• State Fortn 43709 (R6l 5-06) � �
•� Presaibed by Depariment of Lonl Govemmem Finance �"'1 � � l
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INSTRUCTIONS � AUG OFEe MEMt
To be filed in person or by mail with the County Auditor of the county whe�e the proped,v is located.
Filing Dates: 1) Real P�operty: Dunng the 12 months before ,lune I7 0l the yea� the deduction is to be effe��„ ,Q
2) Mobile Homes assessed under IC 6-1 JJ: Between January 15 and March 2 0( the year the dedG�tion i� be e ryective.
See reverse side for additional inshuctions and qualifications.
GIBSON COUNTY AUDITOR
or contract buyer - sQ�
i
-G✓�--C�- C
Distrid
�� .
Assessed value of real property as of
AAarch 1, current year
If no, what is his / her exact share of interest?
on reverse side)
V/l.Cil . V\ /�/
Key riumber / legal description
number -
�-o b: �
Page number
a� °/�-l8-/O/-00%iYE-Odb � �3Y
Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equilable
March 1, wrrent year ownef? ❑ Yes 0 No �
3 5� p00 .
If name on record is different than that of applicant, indicate below:
If owned with someone
�me of mortgagee or contrad seller �
/�: .. �' ,
Address of mortgagee or conVact seller (number and stieef, city, state, ZIP
assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applipnt own property in any other I If yes, what county? What Taxinc
county in Indiana?
Deduction approved in the amount of:
20 �� I 20 �
P �
Signature
COUNTY AUDITOR
20 20 20
County Auditor
than spouse, indicate with whom.
❑ Mobile Hane QC 61.1-�
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Dra���er NOs�J�°•� . _�3(� _
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C ��\rO. � 3•�, �V.OV >n
3 No
20
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
�;sident of Indiana and owner of the aforementioned property on March 1, 20
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/No %la-✓�
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person