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A� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
u. ! State Form 43709 (R6I5-O6)
� Prescribed by DepaNnent of Local Gavemment Finance
INSTRUCTIONS:
Count Township Year
�
JUN 1�� @�8�
To be (iled in person o� by mail with the County Auditor of the county where the property is located.
Filing Dates: 1J Real Propeity: During the 12 months before ,lune 17 01 the year the deduction is to be elfe�
2) Mobi/e Homes assessed under IC 6-i. i-7: Between January 15 and March 2 o(the year th� de����s 6e effective.
See reverse side for additional instiuctions and qualifications. GIBSON COUNTY AUDITOR
Appticant (owne� or contract buy r- see restrictiG�erse side)
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Taxing Dislrid Key number legal description Record number
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��Z,e/Nt'p�✓ �la-��-�7'/D�—O�d,49/-p�gPagenumber � 0 7J�
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year March 1, wrrent year owneR ❑ Yes ❑ No
�D DOZJ
If no, what is his / her exact share of interest? If owned wifh someone other than spouse, indicate with whom.
If name on record is different ihan ihat of applicant, indicate below: Is the property in queslion:
�� ❑ Reat Property ❑ Mobile Hane (IC 61.1-n
� me of mortgagee or conVad seller �/� _ _ - - — --
�
Address of mortgagee or conVact selier (number and st2et, city, state, ZIP ; ,I ^�S
' Dra�t�ci• NO .�Z�. UU3 ;, �r�'�..
Name of assignee or olher owner or holder of mortgage
` C:li'(� ��. ......••••��:,........
Address of assignee (numberand sfreet, city, sfate, ZIP code) �G/ �� a U S��
Does appliwnt own property in any other If yes, what county? What Taxing District? , Has this deduclion been requested on
county in Indiana? property for curcent yeaR � Yes � No
COUNTY AUDITOR
DeducGon approved in tlie amount of:
20 �� 20 � 20 D 9 20 20 20 20
� P
Signature County Auditor Date
�We ceAify under the penatty of perjury that the above and foregoing information is true and corred and ihat the applicants was / were
resident o Indiana and owner of the aforementioned property on March 1, 20
Si nat w s/ull nam D Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F resident address of applicani Address of authorized person
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