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;;� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'�i'�� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�'\o-�, . ; +' State Form 43709 (R6 / 5-06)
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Presaibed by Depariment of Loral Govemment Finance
INSTRUCTIONS: �UN O s ZQ�'je Mark
To be filed in person or by mail with the County Auditor ol lhe county where lhe property is located.
Filing Dates: 1) Real Property: Dunng the 12 months bePore June 11 of the year the deduction is to.be �flective.`
2J Mobile Homes assessed under IC 6-1.1J: Between January 15 and March 2 o(the�aT4he�a�ion is to be e(fective.
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See reverse side for additiona/ instiuctions and quali/rcations. GIBSON COUNTY AUDITOR
Applicant (owner
Taxing Distrid
buyer- see restrictio on re rse side)
Key number / legal description
..7/„ — � � � Q �.��i� _ 9�91U
number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
3 so
I( no, what is his / her exact share of interesl? Ii owned with someone other than spouse, indicate wilh whom.
If name on record is dif(erenl than ihat of applicant, indicate below: Is lhe property in question:
mortgagee or contrad seller
of mortgagee or contrad seller (number and stieet, city, state, ZIP
of assignee or other owner or holder of mortgage
of assignee (number and street, city, aQ� � �-�'"
Dt'1\\'CI" \0............�c%.�
Does applicant own property in any other If ye -
county in Indiana? C; d � • • • • "'� �
�3 33, �s0.
COUNTY AUDITOR
Deduction approred in the amount of:
20 O y 20 �_ 20 _� 20 20
� � �
Signature
County Auditor
❑ Real Properry ❑ Mobile Hmie pC 61.1-�
Has this deduction 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 that the applicants was ! were
es�ent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person