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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNEcc
FOR DEDUCTION FROM ASSESSED VALUATION
SUte Form 43709 (R6 / 5-06)
Prespibed 6y Deparimenl of Loml Gwemment Finance
INSTRUCTIONS:
To be frled in pe�son or by mail with the County Auditor of the county where the property is locat�C 1 2 Z�O6
Filing Dates: 1) Real Property: Dunng the 12 months befo2 ,lune Il of the year the deduction is to be elfective.
2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of ear the deduction is to be effective.
See reverse side fo� additional instructions and qualifrcations. �� ��
GIBSON COUNTY AUDITOR
Applicant
Taxing Dislrid
see rej(n�tions on reverse side)
Assessed value of real property as of
March 1, wrrent year
exactshare
Key numTier / leg description Rewrd number
�1G �.���- o�-000.os�-cu�' �6
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MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, current year owne(? ❑ Yes � No
5� 00
If owned with someone other than spouse, indicate with whom.
If name on rewrd is different ihan that of applicant, indicate below:
of mortgagee or contrad seller
Address of mortgagee or conVad seller (number
of assignee'orother owner or holder of mortgage
pty.
ot assignee (num6er and street, city, sfate, ZIP code)
Does applicant own property in any other I If yes, what county?
counry in Indiana?
Dedudion approved in the amount of:
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Signature
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is the property
❑ Real Properry ❑ Mobile Home QC E1.1-�
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What Taxing District?
Has this deduction been requested on
property for curtent year? � Yes ❑ No
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Dra�ver NO.. �Q�o
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/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owqer of the aforementioned property on March 1, 20
�33 �•'�G,�s� �
executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person