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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S / State Fwm 43709 (R4 / 10-01)
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Prescribe0 by DepaMrent of Local Govemment Finante � ��
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INSTRUCTIONS: File Mark
To be filed in person or by mail with fhe County Auditor o/ the county where the property is Iocatc�.0 � 1� Z��2
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 of the year the deduction is to 6e eNective.
2) Mo6ile Homes assessed under IC 61.1-7: Between January 15 and March 31 of the ye th�educti�o�n is/,/{o 6e elfective.
See reverse side lor additional inst�uctions and qualifrca6ons. 7Y�� I
` GIBSON COU"T. Y 4UDI7QR
Applicant (owner or ct buyer - see restricf side)
Tauing Distrid Key number egai description Re rd number ^
d
�� � �OO r/�a� -0� Page number �7�, /�
x / ��
Assessed value of real pro rty as of Mortgage / Contract indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1�nl year owneR ❑ Yes ❑ No
�S o c� 3q,9�
If no, what is his / her exact share of interest? f owned with someone other than spouse, indicate with whom.
If name on record is different ihan ihaf of applicanl, indicate below: Is the property in question:
❑ Real Properly ❑ Mobile Home pC 61.1-�
�me of mortgagee or contract seller
- . oc�- 3 L 7
Address of mortgagee or conVad selier (number and street, aty, sta , ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sheet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curtent yeaR � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �,� 20 �� 20 20 20 � 20 �_ 20 _Q�
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Signature County Auditor Date
� We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
r owne/s lull name) Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
Full r' ent a dress of ap ' nt �, � dress of autho 'zed person
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