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� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
i � FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� ! State Fam 43709 (R6 / 5-06)
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Presaihed by Oaperiment of Loml Gwemment Finance _ __
INSTRUCTIONS: File Marfc
To be filed in person or by mail with the County Auditor of the counfy where the p�operty is located. MAY 2 2 Z�O�
Filing Dates: 1) Real Property: Durtng the 12 months belore ,lune I1 of the year fhe deduction is to be effective.
2) Mobile Homes assessed unde� IC 6-7.1-7: Between January 75 and March 2 of the year the de � n is t��efiective.
See reverse side for additional instnictions and qualifications. � Q'
� GIBSON COUNTY AUDITOR
(owner o� contrect buyer - sqg 2sMcf�ons on �everse side)
Taxing District
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Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
Key number / legal descriptlon Record number
�G /� G � 3�.� ��a. �Z��- �a�'
Penc n��mhur � /� �
7
March 1, current year
as oi Is the applicant the soleiegal or
owner? � Yes ❑ No
�`.' / �
If owned wi h someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below:
�e of mortgagee or contract seller n�� �
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Address oT mortgagee or contract seller (number and st e cr , state, ZIP
owner or holder oi mortgage
ot assignee �numder ano s[reet, crry, srate. ur coae�
Does applicant own property in any other I( yes, what county? What Taxing District
county in Indiana?
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Signature
COUNTY AUDITOR
in the amount of:
zo �� 20 0 9 Zo 20
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County Auditor
❑ Real Properry � MoWe Hwrie pC 61.1-7j
l �.;,....�,,..�
I
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Date
b?-3�5�
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certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was 1 were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed
or by IC 6-1.1-12-.07
person