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/il � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i'�; FOR DEDUCTION FROM ASSESSED VAIUATION Coun Township Year
• State Form 43709 (R6l SO6)
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Aesaibed by Depariment of Local Govemment Finance
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INSTRUCTIONS: File MaAc
To be filed in pe�son or by mail with the County Auditor of the county, where the p�operty is located. �UN 2 2 Z���
Filing Dates: 1) Real Property: During the 12 months before ,lune I7 of the yea� the deduction is to be effective. -
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oI the year the �tion is�� eflective.
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See reverse srde for additional instiuctions and qualifications. ��
GIBSON COUNTY AUDITOR
Applicant (owner
Taxing Distrid
- see
Assessed value of real property as of
March 1, currenl year
If no, whai is his / her exact share of interest?
Key number / legal description Record number y� �]
CJ /
(W/_� /'"(0 3 —�W•7 ��dlvber 2
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Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
l50 o�c
If owned with someone other lhan spouse, indicate wilh whom.
If name on record is different ihan ihat of applicant, indicate below:
mortgagee or contrad seller
of mortgagee or conUact seller (number and st2et, city, state, ZIP
ot assignee or other owner or holder of mortgage
street, city, state, ZIP code)
Does applicant own property in any
county in Indiana?
)eduction appro��ed in the amouni
20 � 20 �
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Signature
If yes, what county? � What Taxing Distrid?
'" •��DITOR
D�'a i v�t. �,0./�
CarV I�rO u �`�y4,�
Is th�pr
� Real
Z�)� G1'1
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❑ Mobile Home pC 61.
Has this dedudion been requested on
property for wrtent yeaR� Yes❑ No
20
Date
20
We ceAify under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
resident of Indiana and owner of the aforemenlioned propeRy on March t, 20
(owners full name)
Person authorized by duty executed Power oi Attomey
or by IC 6-1.1-12-.07
dent address of appliqnl Address of aulhorized person
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