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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�� �� J State Form 43709 (RS / 4-03)
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P2scnC¢tl py Department of Loral Govemment Finance
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�NSrRUCr�oNS: FEB 2Hk2�
To be filed in person or by mail wiih the County Auditor of the county where the property is located.
Filing Dates: 1) Real PropeRy: During the 12 monfhs 6e(ore May 11 of the year the deduction is to be e/%cA,tj�.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( t6e year tpe dedvucf�r��uto be effective.
See reverse side (or additional instructions and qualificafions. GIBSON COUNTY AUDITOR
Applicant (owneror contract buyer- see restrictions on reverse side)
.-, . .
Taxing Dislrid
,
Assessed value of real property as of
Marcb 1, curcent year �_
If no, what is his / her exac[ share of interest?
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Key num / legal descripti Record number
d�-ld-!8-ao/-00%D�Y-o,�8 0 ^l
Page number
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MoAgage / Contrect indebtedness unpaid as of Is the applican the sole legal or e
March 1, current year owner? s � No
5 � a.� b
If owned with someone olher than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contrad seiler
Address o( mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing C
county in Indiana?
20
Signature
approved in the amount of:
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COUNTY AUDITOR
2o Oq 20 20
County Auditor
prope.rty in question:
❑ Mobile Home (IC Cr1.1
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C` �"�� mA'�wp��; S�vK�
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20
Date
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certify under the penalty of perjury that the above and foregoing information is true and correc[ and that the applipnts was / were
lenl of Indiana and owner of the aforementioned property on March 1, 20
Signature (ow rs lull name)
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Full resident addres of appiicant
�P �� O/ cS • Se�;na�y S-}-
Person authorized by duiy executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person