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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�! State Form 43709 (RS / 4-03)
� PresaiDetl by Depanment of Lxal C,ovemment Finance
Coun Township Year
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INSTRUCTIONS: F�UNaL O
To be filed in person or by mail with the CountyAuditor of the county whe2 the property is located. 2��6
Filing Dates: i) Real Property: During fhe 12 months before May 11 of the year the deduction is to be ellective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduc`tiojviS to be elfective.
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See reverse side for additional instructions and qualifications. C/
GIBSON COUNTY q{�B170R
Taxing Dislrid
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Assessed value of real property as of
March 1, wrrent year
If ,io, what is his / her exact share of
Key number / legal description Record number �
�G �9_if' a�o-a��oGG-a��
DO � - 0/066 -oc� Page number � � �
MoRgage / Contrad indebtedness unpaid as of Is the applicant lhe sole legal or equitable
March 1, current year owne(? ❑ Yes ❑ No
/3s �
If name on record is different than thaf of applicant, indicate
,me of mortgagee or coniract selier � � �
Address of mortgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
If owned with someone olher than spouse, indicate wilh whom.
city, state, ZIP
(number and sfreet. r.ity, state. ZIP code)
Does appliwnt own property in any ofh�r I I! ���.�� what county? bVhat Taxing District?
county ir Indiana? � I
� COUNTY AUDITOR
DeduCtion appro��ed m the amnnnt qt:
- — - --- - - — � — —
zo 2n I,o_Oq_— zo Zo
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Signature
Counly Audifor
r,. Vb'�7b]
s the property in question:
❑ Real Property O Mobite Home pC 61.
Has this dedudion been requested on
property for wrrent year?� Yes❑ No
20
Date
20
' VJe re�iif�j under ihe p:analty of perj��r� rhaf tne above and forcaoino fnfoTnation is tru� and corred and ihat ihe applicants was / were
resirient of Indiana snd owner of thA afnrementioned property on March L 20
Person aulhnrizeA by duly executeA Power of Httomey
or by iG 6-1J-12-.07
address of ao�licant � n IAddress of authorized person