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i l'" A� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i' � FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
/ State Form 43709 (R6 / 5-06) . . � � � �
�� M Resvibed by Department of Lwal Gwemmenl Finaixe
wsrRUCrioNS: OC f 1 2 2�Ma�x
To be filed in person o� by mail wdh the County Auditor of the county where the p�operty is,located. �
Filing Dates: 1) Real P�operty: Dunng the 12 months before June Il of the year the deduction is to be�'erlive,Q�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 0l the year fh�deduc n is to be e/fective.
�IBSON COUNTY AUDITOR
See �everse side for additional instnictions and qualifications.
Applicant (owner
Tauing DislriC �
�i���-�
Assessed value af real property as of
March 1, curtent year
If no, what is his / her exad share of interest?
If name on record is difterent than that
of martgagee or contrad seller
side)
description � Record number
�'1/ � o�-� /-�����/ S/�o P�gnumber a9 D
p(l0 �' 0
Mortgage / ContraG indebtedness unpaid as of Is the applicant ihe sole legal or equitable
March 1, cu ent year ownef? ❑ Yes ❑ No `
' ��SoO
-�� ,`.
Address of moRgagee or conVad seller (number and
or other owner or holder ot mortgage
Address of assignee (number and street,
If owned with someone other than spouse, indicate with whom.
below:
city, state, ZIP
Does appficaM.�-•--� (; �unty? What Taxing District?
counly � �{/j�.. lp � 7�
Dra�ver N���,lt�
Card N�• ......�• • •: •'�' jj �
� COUNTY AUDITOR
Deductio n _�'� � a p"f�
Ni /!CG�P
20 C�7 �/��'�'j 0 3�• O� �„ 20 20
� I �
Signature
County Auditor
Is the property in question:
� R4al Property �p Mobile Home (IC Fr1.1
Has this deduclion been requested on
property for wrtent yeaf? � Yes� No
20
Date
20
We ceAi(y under lhe penalty of perjury that the above and (oregoing infortnation is true and corred and that the applicants was / were
�esident 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
of authorized person