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/e` '� Ay STATEMENT OF MORTGAGE OR CONTRACT INDEE3TEDNESS
�i'�; FOR DEDUCTION FROM ASSESSED VALUATION
�j• State Fortn 43705 (R6 / 5-06)
� Presaibed by Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with lhe County Audilo� ot the county whe�e the property is located. ��u� ] ZQOl
Filing Dates: 1) Real Property: Du�ng the 12 months before June 11 of the year the deduction is to bei-tw�bYe.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of the year the deduction is lo be eflective.
See �eve�se side /or additional instructions and qualificatrons. aU�. '�
GIBSO�VUNTY AUDITOR
buyer- see restrict"��n reverse side)
Taxing
Assessed value of real property as of
March 1, current year
If no, what is his / her exad share of
F(Sy nUmber / legal description �-- Record numbero �_� I� �
a�_I� I_ / b� � Pa enumber
MoAgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, cunent year ownef? ❑ Yes ❑ No
��- Ooa �
If owned with someone other than spouse, indicate wilh whom.
If name on record is dif(erent than that oi applicant, indicate below:
�me of moRgagee or conVad seller �
• � �
Address of mortgagee or contraG seller (number and streef, 'ty, state, ZIP
Name of assignee or other owner or holder of mortgage
(num6erand st2et, city, stafe, ZIP code)
Dces applicant own property in any other I If yes, what county? I What Taxing Dislrid?
county in Indiana?
Deduction approved in
Zo � zo
�
Signalure
I � ��flA C�> �y0?�
theamountof: ,,,��^/ dQJ�(�n„�- (� M
_D ���.'..i.ai`
��a3 �'�19�600. °°
s`�- �°- , 07-su'i
County Auditor
property in question:
0'•-'.� �
61.
Has this deduction been requesled on
property for current yeaR � Yes ❑ No
�o
Date
zo
We certify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person