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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S�ate Fwm 43709 (R6 / 5-06)
Presaibed by Department of Lwal Govemment Finarxe
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Coun Township Year
1 �
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of fhe county where the property is loca�p � 7 Z��$
Filing Dates: 1) Real Property: During the 12 months befora �une 17 o/!he year the deduction is o 6e elfect�ve.
2) Mobile Homes assessed under lC 6-7.7-7: Between January 15 and March 2 of the„y��t� � ction is to be eflective.
See reverse side /or additional instructions and qualifrcations.
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GIBSON COUNTY AUDITOR
Applicant (owner or co ct buy - see�2stri 'o on reve e side)
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Taxing Distrid Key number gal description Record number `�
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y�/�Of � 8
Assessed value of real p operty as of Mortgage / Contrad indebtedness unpaid as of Is the applitant ine ���a legal or equilable
March 1, current year March 1, cur�ent year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? f owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below: Is the property in question:
❑ Real Pioperty ❑ Mobile Hane pC 61.1-�
ie of mortgage — "---' °=��as
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Addressofmorte Dra�veri�r� �7pQ�.(�G/ de,
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Name of assign '
�/�j ,C,�ard1'
Address of assignee (numde���. ��3� S"� �ee
Dces applicant own property in any other If yes, what counry? What Taxing District? Has this dedudion been requested on
county in Indiana? property for curtent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �`� 20 �_ 20 20 20 20 20
P �
Signature County Auditor Date
e certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and ihat the applicants was / were
asident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners ful ame) Person authorized by duty executed Power of Attomey
or by IC E1.1-12-.07
f II residen a ress of applipnt Address of authorized person
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