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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R4 / 10-01)
P�escriDeO by Depanrren� W Loral Govemment Finante
INSTRUCTIONS:
To be filed in person or by mail with fhe County Auditor o/ the co�nty where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ fhe year the deduclion is to be effe�iv�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0l the year the d
See reverse side tor additional instructions and qualifica6ons. �, �
0 a 2003
eduction is to 6e eHective.
" GIBSOtJ COU
Applicant (owner or contract buyer- see restrictions on reverse side)
Tauing Distri Key number / legal de ption Record number
�
' Page number
00 �- b t
Assessed value of real property as af Mortgage / Contract indebtedness unpaid as of Is the applicant
March 1, curtent year March 1, current year owneR (
If no, what is his / her exact share of interest?
v
sole legal or
�es ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below:
'�ame of mortgagee or contrad seller
I�.:�.�,Je.�� u--�o �
Address of moRgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? I What Taxing District?
county in Indiana?
Deduction approved in the amount of:
20 �_
Signature
COUNTY AUDITOR
r'�/L-�rI4'fZi7
County Audftor
O Modle Harne OC 61.
Has this dedudion been requested on
property for curcent yeaf? � Yes � No
20 U / 20 _
f
Date
20 O q
�`�
/ We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of ihe aforementioned property on March 1, 20
Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
Address of authorized person
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