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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slata Fortn 43709 (RS / 4-03)
P25criEed by Depanment of Local Govemment Finance
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UCTIONS:
filed in person or by mail with the County Auditor of the county wAere the property is /ocated. �� C iiii O 3
Fiiing Dates: 1) Real Property: Dunng the 12 months before May 11 01 fhe year the deduction is to be effec ive. q Z �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the ear�tion,is to be e/%ctive.
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See reverse side for additional instructions and quafiTcations. J��,_,
GIBSON COU1fTY AUOITOR
buyer - se estnct' ns on reverse
Key number / le�.
Assessed vatue of re I p pert}
March 1, curtent year
If no, what is his / her exact shs
If name on record is difterent th
Name of mortgagee or conlract
as of
of
) M/� � �� I Page number
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Mortgage / Contract indebtedness unpaid as of I Is the applicant the sole legal or equitable
March 1, current ye� owner? ❑ Yes ❑ No
of mortgagee or contrad seller (number and street,
or
owner or holder of mortgage
Address of assignee (number and street, city, state,
I( ovmed with someone other than spouse, indicate with whom.
state, ZIP
❑ Real
❑ Mobile Home (IC 61.
Does applicant own property in any other If yes, what counry? What Taxing District? Has this deduction been requesied on
counry in Indiana? property for current year? ❑ Yes❑ No
COUNTY AUDITOR Drawer NO. n.�. �„9��z -
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Signature
approved in the amount of:
�IL��/L��
Counry Auditor
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I
CardNO . .....................
Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
iresident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person