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�eF ~ A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� � Count Township Year
�' ; FOR DEDUCTION FROM ASSESSED VALUATION
��... u. -y SUte Form 43709 (R6 / 5-06)
Prescribetl by Deparimenl of Local Gwemment Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the Cowty Auditor of the county where.the property is locateo'� E � 2�- 2��6
Filing Dates: 7) Real Property: Du�ng the 12 months befo2 ,lune �l o(lhe year lhe deduction is to 6e eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l ths-ye r the ded c6on is to be e(fective.
See reverse side (or additional insfructions and qualifrcations.
4��� �� �
/ GIBSON COUNTY AUDITOR
on reverse side)
description
Record number � /
03 3 -A�?a ��
`j�-� // ���� �� Page number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
no, what is his / her exact share
Ii owned with someone other lhan spouse, indicate with whom.
If name on record is difterent than thaf of applicanl, indicate below:
ame of mortgagee or conVact seller \!r1 ,_��
� �:/ 1X1,� \�
r c
Address of mortgagee or contrad seller (number and street, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP aode)
Does applipnt own pn
counry in Indiana?
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What Taxing District?
�
�iO . ..................... �NTY AUDITOR
Deduction approved ii
20 O �.. �.., __ 20
P P P
Signature County Auditor
s lhe property fn question:
❑ Real Property ❑ Mobile Home QC 61.
Has this dedudion been requested on
property for current yeaf? � Yes ❑ No
�
Date
20
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal the applicanls was / were
resideN of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly exewled Power of Attomey
or by IC 6-1.1-12-.07
ent add�ss of ap lipnt Address of authorized person
3 os 6�2�v� s s� PATvK�-