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� ��p STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'sr I' � FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�� ! Stata Fmn 43709 (R815-06) � � �
� Prasvibetl by DeperlmeM of Local Gwemment Finance � F�
V
INSTRUCTIONS: SEP 2 $F���
To be filed rn persan or by mail with the County Auditor o/ the county where the p�operty is located.
Fifing Dates: 1J Rea/ Property: During fhe 72 months before ,lune I7 0/ the year the deduction is to be e� ve. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yeaf the' °�Gc� to 6e eBective.
See reverse side for additional instructions and quali�cations. GIBSON COUNTY AUDITOR
(owner a
AssessedYreh�s o1 re;
March 1. eu►en! year
�t.no, wnat is
act buy r- see restridions on reverse si�
N N
Key number / legal
exact
Record number � p �
o?lc 'II "U �J-oZDO-DO �• 7� �- Page number a� 9 6
as of Mortgage / Cantract indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year owneR ❑ Yes ❑ No
� /a� o00
If owned with someone other than spouse, indicate with whom.
If name on rewrd Ig diflereM than that of appticant, indicate below:
�e of moAgegee or contracf seller �/ �
. � � � .� � � � .
Address of rtpAgagee'pr conUad seiler (number and straet, aty, state, ZIP
Name of esapnae a, other owner or holder of mortgage
aseignee (number and sheet,
Does app6carM own property in arty other I If yes, what couniy?
county in In�iana4
approved in the emounf of:
zo __�g_,�'
SignaWre
Is the pr
❑ Real
❑ Mobile Hane OC 61.
� �
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COUN"� ��/
20 � zo_
County Audilor
� We certify under tha penalty of perjury that the above and (oregoing i
esident of IrMiana and avner of the aforementioned property on Marc
quested on
� Yes ❑ Na
{� j� Q ry _ �%. —/ � �P —
°��J �� a7� oao °� -
�"�3 �� �' l
corred and that the applicants was / were
S`ig'n^ature (ownere (ull na^me) Person authorized by duly executed Power
�[�. �S a r� �;, . n i�J�,. � n n or by IC 6-1.1-12-.07
of authorized person
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