Mortgage_Opiparie:� "� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�� !• Stale Form 43709 (R6 / 5-061 �}� ```�pp----���
� Presaibed by Departmant of Local Govemment Financa �� � ��
1 11 JLJ JLJ .iLI
INSTRUCTIONS: APR SFL�U1�
To be �led in person o� 6y mai/ with the County Auditor of the county whe�e the p�operty is located.
Filing Dates: 1) Real Property: During the 12 months befoie ,lune 11 of the yea� the deduction is to be e/fec6ve.
2) Mobile Homes assessed unde� IC 6-1J-7: Between January f5 and March 2 of the yea`Gthe4deductlon_is to be effectrve.
See reverse side fo� additional instnic6ons and qualifications. � G
GIBSON COUNTY AUDITOR
see smcnon:
I
Key
Assessed value of real property as of
March 1, curtent year
If no, what is his / her exact share of interest?
side)
description
March t, curzent year
It name on record is different than that oi applicant, indicate below:
or mortgagee or convaa
of moRgagee or contract seiler (number and street, city,
rvame or assignee or omer owner or no�aer or mortgage
ot assignee �numnerano srreer, ary, srace, ar coae�
as
Record number
: uuuiuw �a 3 9
Is the applicant the sole�legal or
owner? � Yes � No.
If owned with someone other than spouse, indicate with whom.
Does appliqnt own property in any other If yes, what county? I What Taxing DisVic
county in Indiana?
ueaucuon approvea in me amount ot:
20 Q'L 20 � 20 O'
� �
Signature
COUNTY AUDITOR
20
County Auditor
20 _
I/ We certify under the penalty of perjury that the above and foregoing infortnation is W__... _.
�sident of Indiana and owner of the aforementioned property on March 1, 20
or by IC E1.1-12-.07
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of authorized person