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i i ', STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�9'�' FOR DEDUCTION FROM ASSESSED VALUATION
fJ State Form 43709 (R6 / 5-06) � .
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Presoibed by Depariment of Local Govemment Finance
INSTRUCTIONS: -
To be filed in person or by mail wdh the CountyAuditor ol the county where the property is located.
Filing Dates: 7) Real Property: Dunng the 12 months be(ore June �t of the year the deduction is to be e,�r�a1 5 2001
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year t�deduc6on �s to be effective.
See reverse side for additional instructions and qualifications. �,Q�
^ ^ GIBSON CO(�Njy AUn�rno
ApplicanY (owne� or contracf
Taxing Distrid
Assessed value of real property as of
March t, current year
what is his / her exact share of
Key �fmber / legal description Record number OC '
c�,b��� ��-CLb-aSi-�a�' � -�
Page number � �
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, �nt year owneR ❑ Yes ❑ No
. 7000
If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below:
of mortgagee or contrad seller
Address of mortgagee or contract selier (number and street, city,
Name'of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
ZIP
Does applicant own property in any other I( yes, what county? What Taxing Distrid?
county in Indiana?
- COUNTY AUDITOR
--� --
Dedudion -
20 �
�
Signatui
D�.�uss GE�PA�D lj.encJl'
d � -.��53
�
Auditor
20
s the property in question:
❑ Real Properiy ❑ Mod'� Hane QC 61.1-�
nas mis aeauaion oeen requesiea on
proPerty for current yea(.� � Yes � No
zo
20
certify under the penalty of perjury tha[ cn� ..__ . nnd foregoing informalion is true and corred and thal the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized b�
or by IC 6-1.1-12-.07
4ddress ofauthorize<
executed Power of Attomey
person
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