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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
: ����� �? State Form 43709 (R51 d�3)
� P2saiDeO by Departmem ot Local Govemmen� Finatxa
INSTRUCTIONS: - �
To be filed in person or by mail with the County Auditor ot the county where the property is located. QC r O,�
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is fo be et(ecfive. Z005
� .� 2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be eNective.
See reverse side for additional instructions and qualiTcations. ��a� ��
-^ —` - �GIBSONCOUNTYa���,_--
Hppucant o�anerorcQntrac bu �-s
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Taxin ' trid �
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Asses ed val e of real property as of
March 1, wrrent year
If no, what is his ! her exact share of ii
If name on record is different than iha
,3me of mortgagee or contraci seller
Key number / leg�l descr�ption Rewrd number
/*( / ,� /n /S / 7 �' O � Page number
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Mortgage / ContraG indebtedness unpaid as of Is the appli
March 1, current year owner?
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of applicant, indicate below:
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t the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrad seller (number and street, city, sfate,
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand sVeet, city, state, ZIP code)
Does applicant own propeRy in any other If yes, what county? What Taxing Distrid?
county in Indiana?
COUNTY AUDITOR
Deduction approved in lhe amount of:
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Signature
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County Auditor
U
Hane pC 61.1-�
Has this dedudion been requested on
property for current year? �] Yes � No
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Date
20
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident ad�essRf`a�plicant n n � �Address of authorized person