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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (RS / 4-03)
Prescn�ed 6y Departmem of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county wAere the property is located. FEB 2 2 2005
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year fhe deduction is to be eHective.
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the {leduction is to 6e effective.
See reverse side for additional instructions and qualilcations. ��16� �
GIBSON COUN7Y� �TOR
Applicant (owner�r�Cpntract buyer
Taxing District
on
Key number / legal
Record number
� O� _ OO C -� Page number �
J
sse ed val real pro s of Mortgage / Conlrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curte ear March rrent year � owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? Ii owned with someone other than spouse, indicate with whom.
name on record is diHerent than tFiat of applicanf, indicate below:
of mortgagee or wntrad seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what counry? What Taxing District?
county in Indiana?
COUNTY AUDITOR
Is the propeRy in question:
❑ Real Property � Mobile Home (IC 67.1-�
Has this dedudion been requested on
property for current year? � Yes ❑ No
Deduction approved in the amount of:
20 Q� 20 p'� � 20 20 20
.� pR��� y � �E t�� ?
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Signature _ Date
i/ We certify unde V�/�� �� .._ auove and foregoing information is true and corred and lhat the applicants was / were
residenl of Indiar .,�e aforementioned property on March 1, 20
resident
executed Power of Attomey
or by IC 6-1.1-12-.07
address ofauthorized person
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