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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R4 / 10-01)
PrescTibeA by Depanmenl W Local Govemmem Fiiunce
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor ol the county whe2 the propeRy is located. (��r Z��Z
Filing Dates: 1) Real PropeRy: Dunng the 12 months befo2 May 11 0l the year the deduction is to 6e 8ifebti� �
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ year the deduction is to be eNective.
See reverse side /or additional instnictions and quali�cations.
' GIBSON OU TY fiUDITOR
Applicant ( er or cont ct buy - see re 'ctions on reverse side)
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Ta�cing istrid ey num / legal description Record number �
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent ear March 1, current ear 2 owne(? ❑ Yes ❑ No
Y �,Y v1
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diiferent than that of applicant, indicate below: is the property in question:
❑ Real PropeAy ❑ Mobile Home QC 61.1-�
�me of moAgagee or conVaIX seller
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Address of mortgagee or conVact seller (number and street, aty, stat , IP
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Name of assignee or other owner or holder of mortgage �`
Address of assignee (number and street, city, state, ZIP code)
Dces applicant own property in any other If yes, whal county? What Taxing Distrid? Has this dedudion been requesled on
munty in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signalure County Auditor Date
�/ We certify under lhe penalty of perjury ihat the above and foregoing infortnation is lrue and cortect and thal ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Sign re (owne�s /ul e) Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
Fu I resident address of app Address of authorized person
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