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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� w� �J State Form 43709 (RS / d-03) . . .
� Presaibed by Depanrtreni of Loral Govemment Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where fhe property is located. FEB 2 1 2��%
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be ef/ective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yea� tt+e�eduction is to be eHective.
See reverse side for additional instructions and qualifications.
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GIBSON COUNTY AUDITOR
Applicant
Taxing
buyer-see
Assessed value of real property as of
March 1, currenl year
If no, whaf is his / her exact share of interest?
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Key number / legal description Record number /
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(1 /Q � O// � q O� Page number � n�/
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Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
ffi(p�DOD
If name on record is diHerent than that of applicant,
of mortgagee or contracl seller
Address ot mortgagee or contrad seller (number and
Name ot assignee or
owner or holder of mortgage
If owned with someone other than spouse, indicate wilh whom.
below:
city, state, ZIP
Address of assig `'-��m6erand street, city, state, ZIP code)
Does applicant D�- `"��rAUfliY� What Taxing Distrid?
county in Indi; a�s'�r 1\rO �1�0 -� \
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CarU ��,� ���'`,� / ,
Deduction approved in n�� _
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Signature
20 _��_
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ITY AUDITOR
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20 0 9 20
P
Couniy Auditor
Is the
❑ Real Property ❑ Mobile Hmie (IC 61.1-�
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Has this dedudion been requested on
property for current yearl �] Yes � No
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certify under the penalty of pery'ury that the above and foregoing information is tme and wrrect and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ignature (owners lull na�
u I resi�ress of ��,
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Y'I!. '?G
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-72-.07
Address of authorized person