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�e` �' g STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's� Y FOR DEDUCTION FROM,ASSESSED VALUATION
. y State Fortn 43709 (R6 / 5-06) ' ' ' ' '
�•� Presaibed by Department of Lonl Govemment Finarice
INSTRUCTIONS:
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To be /iled in person o� by mail with the CountyAudito� of the county where the property is located.
Filing Dates: 1J Rea/ Property: During the 12 months befo2 ,lune 11 of the yea� the deduction is to be eflecti��P 1 4 2001
2J Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 o(the year the deduction is t�ef(ective.
See �everse side for additional insfiuctions and qualificalions. �� �
GIBSON COUNTY AUDITOR
Applicant (o rorcontracf buyer- restricti ns o ieverse side)
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Taxing Dislrid Key number / legal des tion Record number
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{'� , C� / � Q'I a' _ � � Page number , /(1, ��
ia•i pilo ( o i-i'7
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant lhe sole legal or equitable
March 1, curtent year March 1, curtent year owner? ❑ Yes � No
a �� c� - . .
Ii no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below: Is the property in question:
❑ Real Propaty ❑ Mohile Hmie (IC fr1.1-n
�me of mortgagee or contract seller
� �
Address of mortgagee or contrad seller (num er and street, city, state, ZI
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other if yes, what county? What Taxing District? Has this deduction been requested on
wunty in Indiana? property for curtent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 � 20 20 20 20 20
� �
Signature County Auditor Date
�` We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
esident of Indiana and owner of th aforementioned property on March 7, 20
\�a r(owners full n e) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F II resident address of applican Address of aulhorized person
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