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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Siate Fwm 43709 (R5 / 4-03) .
PrnscnDed by Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o! the county where the property is located. luf d R 3 0 Z��S
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0l the year the deduction is (o be efl2c�ibe.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yea�r-tyh,e, deduction is to be effective.
See reverse side for additronal instn�ctions and qualifications. O'/a� ,G��
GIBSON Cl
n COUNTY qUDlTna
(owner or contract t�r- see
Key number / �egal description
number
'J�////�/,,,, y�'), v �/�_��a�9.� Pagenumber
/ �(i�/�l��Xil�� �L
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year March 1, wrrent year owne(? ❑ Yes ❑ No
If no, what is his / her exact share of interest?
If name on record is different Ihan lhat
ot mortgagee or contred seller
Address of mortgagee or contract seller (number
indicate below:
Name of assignee or other owner or holder of mortgage
city,
of assignee (number and street, city, state, ZIP code)
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If owned with someone other lhan spouse, indicate with whom.
Does applicant own propeRy in any other I If yes, what county? What Taxing Distrid?
county in Indiana? _
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Dra�verNO...V�wY•••••• COUNTYAUDITOR
Dedi
Card \`O. ..���.........
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Signature
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County Auditor
20
Is the propeRy
❑ Real Property ❑ Mobile Home (IC 61.
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Has this deduction been requested on
property for current yearlQ Yes❑ No
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certiy under the penalty of perjury lhat the above and foregoing information is true and corred and thal ihe applicants was / were
ient of Indiana and owr�er of tl�e aforementioned property on March 1, 20
full
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person