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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR�DEDUCTION FROM ASSESSED VALUATION
Slate Fwm 43709 (RS I 4-03) �
PtesuiEed Ey Department of Local Govemment Finance
Coun Township Year
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INSTRUCTIONS: � �p��� �
To be filed in person or by mail with the CountyAuditor of the county whe�e the property is located. iviAR 1 � 20�6
Filing Dates: 1) Real Property: During the 12 months be7ore May 11 0/ the year the deduction is to 6e eliective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year��l�y/� deducti n is to 6e effective.
See reverse side /or additional insWctions and qualifications. "� a� ��
GIBSON COUNTY AUDITOR
Applicant (owner or contracf
Taxing Dislrid ' �
Assessed value of reai property as of
March 1, curcent year '
is his / her exact share of interest?
on
/ legal description (�� Record number
O I I.-0' Q Q a'� Page number O O
Mortgage / Contred indebtedness unpaid as of Is the applicant the sole legal or e
March t, current year owneR ❑ Yes ❑ No
If name on record is different than that of applicant, indicate
of mortgagee or contract seller
Address o/ mortgagee or contrad seller (number and street, cify,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and strnet, city, state, ZIP code)
If owned with someone other than spouse, indicate with whom.
Does applipnt own property in any other If yes, what county? What Taxing Distrid?
munty in Indiana?
.. COUNTY AUDITOR
Dedi Dra�� er N�.:^� �
zo_ Card \O. .... g�./........ 20
!��I 50, Goo. � �
_ v�cz+nono� YrS�c..� �ic/. C'• ll -
Signature
County Auditor
20
Is the property in question:
❑ Real Property O Mobile Hane pC 61.1-�
Has this deduclion been requested on
property for current year? � Yes � No
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Date
zo
We certify under the penalty of peryury thal the above and (oregoing information is true and corred and ihat the applicants was / were
�esident o� Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly
or by IC 6-1.1-12-.07
of authorized person
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Atlomey