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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R4 / 10.01)
PrescnDed Dy Deparimenl o! Local GovemmeN Finance
INSTRUCTIONS:
To be filed in person or by mail with [he County Auditor ol the counfy where the propeRy is located. C�p ,
Filing Dates: 7) Real Property: During the 12 months be%re May 11 of fhe year the deduction is to be e/fc�CtivU. � 6 2002
2) Mobile Homes assessed under IC 6-1.1-7: Belween January 15 and March 31 of th ar the deducti is to be effective.
See reverse side (or additional instructions and quali�cafions.
GIBSON CClll 7v ciinirno
Applicant (owne�o c ntrac buyer- see re � ions on reverse side)
Taxing Disirid Key number / legal description Record number Q'
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole lega or equitable
March t, cunent year March 1, current year owner? ❑ Yes ❑ No
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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 different than ihat of applicanl, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC fr1.1-�
�e of mortgagee or contrad seller �
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Address of mortgagee or contract seller (number and street, city, state, ZIP '
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent yeaf?� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
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i ature _ 0�J County Auditor Dale
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''`Ne ce � under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
si nt of Indiana and owner of the aforementioned propeAy on March 1, 20
Si ture (ownefs full nam Person authorized by duty executed Power of Attorney
or by IC 6-1.1-12-.07
Full re ' ent address of appli nt Address of authorized person
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