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`_��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
s y SUte form 43709 (R6 / 5-06)
� Aesaibed by Department of Lo<al Govemment Pinance
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INSTRUCTIONS: j` �� File Martc
To be /iled in person or by mail with the CountyAuditor o! lhe county where the property is located.
Filing Dates: 7) Real Property: Dunng tbe 12 months be/ore June 17 of the yea� the deduction is to be e�ff cti�e.� ZLJ
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/!he year the deducdon is to be effective.
See reverse side tor additional insWctions and qualifications. ✓���� `"'�Q'
GIBSON CUui.TY AUDITOR
see
Assessed value of real property as of
March 1, current year
no, whai is his / her exact share of interesl?
If name on record is difierent lhan lhat
reverse side)
Key number / legal description � Record number
p� lC _ V S-' lo�'� �d—� ��'� ge number 3 qS--S--
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Mortgage / Contract indebledness unpaid as of Is the applicant the sole legal or equ
March 1, current year owne(? ❑ Yes ❑ No
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If owned wilh someone other than spouse, indicale with whom.
❑ Real Property ❑ Mobiie Hane (IC 61.1
of moAgagee or conVaG
Address of mortgagee or contrad seller
and s�r�eet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (nurrmber and st2et, city, state, ZIP code)
Dces applicant own property in any other If yes, what counry? I What Taxing District? I Has this dedudion been requested on
county in Indiana? property for wrrent year? � Yes ❑ No
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Signature
COUNTY AUDITOR
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County Auditor
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Date
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' We certify under the penalry of perjury lhat the above and foregoing information is true and correct and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
sideN�ddress of ap
63sS"Y�%•
Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
Address of authonzed person