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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. ! State Fwm 43709 (RS / 4-03) � � � 1
�«• �� PfescnbeC by Department of Local Govemmem Finance �
iNSrRUCrioNS: APR 2 7 2006 File Mark
To be filed in person or by mail with the County Auditor ot the county where the property is located.
Filing Dates: 1J Real Property: During fhe 12 months be%re May 11 0l the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of;t�:year fh�deduction is to 6e effective.
U �
See reverse side lor additional ins[ructions and qualiTcations. G�gSON COUNTY AUDITOR
Applicanl(ownerorc � fbuyer-see
Taxing DistriIX
VV • J � --
Assessed value of real property as of
March 1, wrrent year
on
Key number / legal
�o�9-D3ys���a,
Mortgage / ContraG indebtedness unpaid as
March 1, wrrent year
Record number D �
Page number � � 6 3
f Is the applicant the sole legal or equitable
owneR ❑,Yes ❑ No
If no, what is his / her exact share of inlerest? If owned with someone other lhan spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below: Is the property in question:
❑ Real Properry ❑ Mobile Home QC E1.1-
,me of moAgagee or conVact seller
Address of mortgagee or contract seller (number and stre city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee
Does applicant own �
county in Indiana?
Deduction ap�
20
P
Signature _
�We certify
0'
of F
r of
ludion been requested on
wrrent year?� YesO No
20
> and foregoing information is true and corred and that lhe applicants was ! were
property on March 1, 20
Person authorized by duly executed Power o(
or by IC 6-1.1-12-.07
Yess of authonzed person
16 7 C�