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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNEsc
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RS / 4-03)
Piascribetl by Department of Local Govemment Finante
INSTRUCTIONS:
To be filed in person or 6y mail with the Counry Auditor of the county whe2 the property is located � �� � � �
Filing Dates: i) Real P�operty: During the 72 months belore May 11 of the year the deduction is to be eR�chvE005
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of th�-e yy�e,ar the deduction is to be eflective.
See reverse side lor additional instructions and qualifications. ✓'��� ���
GIBSON COUNTY AUDITOR .
see
Taxing Distrid
AsSessed value oi real property as of
March 1, current year
number / legal description
Q �9 -O/33�
Mortgage! Contrad indebtedness
March 1, current year
Record number
' Page number �O q�
O
as of Is ihe applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
If no, what is his / her exact share of interest? � If owned with sameone other lhan spouse, indicate with whom.
If name on record is different than Ihat ot appiicanf, indicate below: Is the property in question:
❑ Reai PropeAy ❑ Mobile Horrie (IC 61.1-�
'me of mortgagee or contrad seller ���
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
Name oi assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, sfate, ZIP
Does applicant own propei a�° � �/� 7 0�"
d�y o�' � �
county in Indiana? —
��a�er �O
Deduction approved in the ;
20
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Signature
2015�c
I
CaYa ��
�q 20_
P
County Auditor
�hat Taxing Distrid?
'TOR
20
Has this deduction been requested on
property for current year? 0 Yes ❑ No
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is lrue and corred and that the applicants was / were
esident of Indiana and owner of lhe aforementioned property on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
rt Address of aulhorized person
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