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/� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i'�; FOR DEDUCTION FROM ASSESSED VALUATION Co T hi ear
�y' • Sfate Fwm 43709 (R6 / 5-06)
�� Presaibed by Deparimenl of Laal Gwemment Finance R 2 6 2008
INSTRUCTIONS: �p���
To be liled in pe�son or by mail with the CountyAuditor of the county whe�e fhe property is located. U
GIBSON COUNTY AUDITOR
Filing Dates: 1) Real Property: Dunng the 12 months before June � i of the year the deduction is to be etTective.
2J Mo6ile Homes assessed unde� IC 6-7.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side for additional instiuctions and qualificalions.
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orcontract
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�r- see restrictions on ieverse side)
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Assessed value ofrealproperty as of
March 1, current year
If no, what is his / her exact
/ legal description ( Record number 2 D D-�
o�.y ',3Q0_l�00, 7 33 -QJS Pagenumber p�Li �
a
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year owneR ❑ Yes ❑ No
3l,000
name on record is difterent ihan ihat of applicant,
It owned with someone other than spouse, indicate wilh whom.
�p��ne of mortgage�trad sel//� ��
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Address of mortgagee or contrad seiler (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(number and st2ef, city, state, ZIP code)
Does applipnt own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amounl
20 �� 20 0 �
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Signature
s the property in question:
❑ Real Property ❑ Mobile Home pC 6�1.1-�
' Dra�ti_er�NO.:a�00..�"l.'.��
Cat;d.N;O��`.�..��}GA'X1:i.°..°...
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What Taxing Distric[? Has this dedudion been requested on
property for cunent year? � Yes ❑ No
COUNTY AUDITOR
20 20 20
County Auditor
20
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforemenlioned property on March 1, 20
name)
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Person aulhorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person