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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fortn 43709 (R4 / 10-0i ) . , �
Prescribed by Depanrtrenl of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county whe2 the property is located.1� �t �. 2003
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0( the year the deduction is to DeteTfecl`ive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31pf the year the deduction is to e eHective.
See ieverse side Io� additional insWctions and qualificaGons. �. ��J �,_,
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� G!BSON OUhTY AUOITOR
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Assessed value of real property as of
March 1, curtent year
If no, what is his / her exad share of interest?
Key number / le� i j s i�t on Record number oO �
Q//, Li�C��E�.1 �� Page number �
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Mortgage / Contrad indebtedness unpaid as of Is the applican the sole legal or equitable
March 1, nt year ownef? ❑ Yes ❑ No
If owned with someone other�han spouse, indicate with whom.
If name on record is diHereni than iliat of applicant, indicate below:
yame o (� /1 ry^ �
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Addres � /� � ty, state, ZIP
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l(h�� �-/ Cl`
wme ,
Addre:
Does a
counh
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Dedui
20 �� 20
Signature
20 �'�
�? Whal Taxing Distrid?
:OUNTY AUDITOR
20G� 20 0%
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County Auditor
Is the pi
❑ Real
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Has this deduction been requested on
property for curtent yea(? � Yes � No
20�_ 20
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Date
/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and thal lhe applicants was / were
tresident of Indiana and owner of the aforemenlioned property on March 1, 20
Power of Attomey
or by IC 6-1.1-12-.07
1 atltlress of applicant Address of authonzed person
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