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,ei ' E STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
;`�� FOR DEDUCTION FROM ASSESSED VALUATION
� .. � Siate Form 43709 (R6 / S-06) , . .
Prescnbed by Departmeni of Lo�ai Govemmenl Finance
(NSTRUCTIONS:
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1 1 ._
File Mark
To be filed in person or by mail with the County Audito� of the county where the p�operty is located. O C T 1 20�%
Filing Dates: 1) Rea/ Property: During the 12 months before June I7 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yeac�Hiae �de.�c n�s to be effective.
See reverse side for additional instructions and qualrfrcations. �� U �
GIBSON COUNTY AUDITOR
Applicant (owner or ntract buyer_see restricfions on reverse side) �
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Taxing Dislrid Key number / legal description Record number �
�'01,' �_ O�_ 0 '� B'on Page number , D
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Assessed vatue of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year owneR ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned wifh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
� ❑ Real Properly ❑ Mobile Horne QC Cr1.t-�
�me of mortgagee or contract seller
Address of mortgagee or wntract seller (number and street, city, state,
Name of assignee or other owner or holder of mortgage -
Address of assignee.(numberand street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Dislrid? Has this dedudion been requested on
county in Indiana? property for current yeaf? � Yes � No
COUNTY AUDITOR
Deduction approved in lhe amounf of:
20 _� 20 � 20 . 20 20 20 20
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Signature County Auditor Date
' We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was ! were
. resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owner's full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person