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� i `,� STATEMENT OF MORTGAGE OR CONTRACT INDE"BTEDNESS
's� = FOR DEDUCTION FROM ASSESSED VALUATION
t. J State Fortn 43709 (R6l 5-06) . . . .
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� Presaibed by Department of Local Govemment Finance
INSTRUCTIONS:
To be liled in pe�son or by mail with the CountyAudito� of the county where the p�operty is.located. �
Filing Dates: 1J Real Property: During the.12 months before June Il of the year the deduction is to be e//e��ii 2 1 Z���
2) Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 of the year lhe� —dye�duction is to be effective.
See reverse side for additional instn�ctions and qualifications. a'`� ��
GIBSON COUNTY AUOITOR
Applicant
Distrid
Assessed value oi real
Ma�ch 1, curcent year
�......_ __.. ..,..��.d� �s on
�' ��""^�" /
Q
as of
ney number / legal descrip�n Record number �
- �5d�-Oa� Page number �� \
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year ownef? ' ❑ Yes 0 No `
S /. �v
IFno, what is his / her exact share of interesl?
If name on rewrd is difterent than that of appliwnt, indicate below:
of mortgagee or contrad seller
Address of mortgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
If owned with someone other than spouse, indicate with whom.
city, stat�IP ,.
1,
Address of assignee (numberand stre�
( U Q ITb�•' , � ED 2G� a S
Does applicant own property in any othi p� N�.� D L
county in Indiana?
Deduction approved in the amount of:
20 �`� 20 �
� Q
Signature
��,S��o
20 20 20
County Auditor
id?
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❑ Mobile Hame (IC 61.1-�
Has this dedudion been requested on
property for current yeaR � Yes ❑ No
�
20
We certify under the penalty of perjury lhat the above and foregoing intormation is lrue and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
W �
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person
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