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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
" FOR DEDUCTION FROM ASSESSED VALUATION
�+ ��� J State Form 43709 (RS / 4-03) � � � ' . .
� PrescdDeE by Department ot Loral Govemment Finance �
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county where the property is located. � 1 2006
Filing Dafes: 1) Real Property: During the 12 months belore May 11 0l the year the deduciion is to beFe�ti .
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side for additional instructions and qualiTcations. `�'Jfa»� ��
GIBSON COUNTY AUDITOR
Taxing
Asse�sed val�of real
March 1, curtent year
see n
�-K-
as of
If no, what is his / her exact share
reverse
Key number / legal description Record number �O�
�� Q/� /„ •��� Page number / /` -
w� � �QCJ
MoAgage / Contred indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
Ob
If owned with someone other than spouse, indicate with whom.
If name on record is different lhan ihat of applicant, in
�me of mortgagee or conirad seller
�A I 1�(\t
Address of mortgagee or wntr selier (number and
Name of assignee or other owner or holder of mortgage
assignee (number and sheet, city,
below:
code)
Does applicant own property in any other I If yes, what counry?
county in Indiana?
Deduction approved in the amount of:
20
Signature
20 O�
ZIP
What Taxing Districi?
COUNTY AUDITOR
20 20 20
/
County Auditor
❑ Real Pioperty ❑ Mobile Horrie (IC 61.
Has this deduction been requested on
property for wrrent year?� Yes� No
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and correcl and lhat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
address of
Person authorized by duty executed Power of Aftomey
or by IC 6-1.1-12-.07
U7(flb��Address of authorized person