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�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s' = FOR DEDUCTION FROM ASSESSED VALUATION
y Siate Fortn 43709 (R6 / SO6)
�M• Presrnbed by Depariment of Loral Gwemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county where the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months before ,lune Il of the year lhe deduction is to be e/%ctive.�l'i,4i� 1 � 200R
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be eiiective.
See reverse side (or additional instructions and qualifications. �%fa� ��
GIBSON COJNTY qUDI
Applicant (o er r tract b�yer - s rest '
Taxing Distrid Key number / legal description Record number D
6—�i�—,�T��-�N� [U Pag�mber � �
v / T/
Asses ed valu f real pro as of MoAgage / Contrad��'���'^^^debtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year March 1, current y� � � y+� 2 � U r' owneR ❑ Yes ❑ No
���0� 7
If no, what is his / her exacl share of interest? If owned with someone olher lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�ne of mortgagee or contrad seller
Address of moAgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of moAgage
Address of assignee (number and street, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county? VYhat Taxing District? Has lhis dedudion been requested on
county in Indiana? property for wrrent yeaf?O Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 � 20 20 20 20 20
f �
Signature County Auditor Date
' We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicanls was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Si ature (owner 1 name) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
Fu I resident address f applicant Address of authorized person
'-�/ 5 � 1n/ DC�..�.t�-� Q.� �'1
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