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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (R4 f 10-07J
PrescribeG by DepaNrent ot Local Govemment Finance
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county where fhe property is locafed. MAY � 9 2��3
Filing Dates: 1) Real Property: During the 12 months be%re May 11 of the year the deduction is to 6e e/%ctive.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of the }rear the deduction(,-�is, to be eHective.
See reverse side for additional instructions and quafifications. �,�,.-,� .Je/ '��.�, 0
GIBSON COU�Tv AUDITOR1
Applicant ( erorcontract buyer- see strictions on reverse '�
Taxing Di t Key number / legal description Record number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the appli nt ihe sole legal or equitable
March 1, current year March 1, currenl year , ownef? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicanl, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
ame of mortgagee or contract seller ,
Address o( mortgagee or conVad seller u b d stree cit�, ate IP
Name of assignee or other owner or holder of rtga e
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Address of assignee (number and street, city, sfate, ZIP code)
Dces applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requesled on
county in Indiana? property for wrtent year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Pv'�t BaR �
Signature County Audilor Date
I! e ceAify under lhe penalty of perjury that the above and foregoing infortnation is lrue and correct and that the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
i ature ners ll ame) Person authorized by duly executed Power of Attomey
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or by IC 6-1.1-12-.07
F I s t a r o appli nt Ad�ss of authorized person
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