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I'
�ei '� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i'�= FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
� i'' State Fwm 43709 (R6 / 5-06) ' . .. . .. ' -.
Resaibed by Deparlment ol Local Govemment Finance
iNSrRUCr�oNS: NOV 1 g Zprp�nna�
To be (iled in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 7) Real Property. During the 12 months before ,lune I7 of fhe year the deduction is to ectiv
, 2) Mobile Homes assessed unde� IC 6-1.7-7: Between January 15 and March 2 o/the�i(� ��on is to be eftective.
See �everse side fo� additional instiuctions and qualifications. GIBSON COUNTY AUDITOR
Appliwnt
6uyer-
Taxing Dislrict ,//���� Key number / legal description F
� _i
- CJ . � `- Q�� F
Assessed value of real property as of Mortgage / ContraIX indebtedness unpaid as of
March 1, current year March 1, current year/ �/OO� 0 0 0
If no, what is his / her exad share of interest?
-'., �i � 8'9 t, indicate below:
� Dra��•er i\O. D% -......... _�
_�
Card ��• .....................
number
number
ownef?
���9 .
t the sole legal or equitable
❑ Yes ❑ No
If bwned with someone other than spouse, indicate with whom.
d street, city. state, ZIP
I__..... „� dssignee or other owner or holder of mortgage
of assignee (num6erand st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty?
county in Indiana?
approved in the amount ot:
20 �
Signature
20 ��
�
❑ Real Property ❑ Mobile Home QC Cr1.1-�
/�/d f $'c�.2 �
G' � c oRRecf I
� t9- q� e �,..,�!.
'edudion been requested on
�r current yean � Yes ❑ No
COUNTY AUDITOR
20 20 20
County Auditor
20
20
3Aify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
nt of India and r of the aforementioned propeRy on March 1, 20
ner full�n me) Person authorized by duly executed Power of Attomey
` , , ��_ __ _ or by IC 6-1.1-12-.07
authorized person