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,a, �"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i��; FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�. . i' State Form 43709 (R6 / 5-06) � . � " �
�iM�
Prescnbed by Depariment of Local Govemment Finance � T�
INSTRUCTIONS: NOV �ilE'M'ark
To be /iled in person o� 6y mail with the CountyAuditor of the county whe2 the propeRy is located.
Fi/ing Dates: 7) Reai Property: Dunng the 12 months 6e%ie ,lune f7 of the year fhe deduction is to be effe� ,Q
2) Mobile Homes assessed unde� IC 6-7.1-7: Between January 15 and Ma�ch 2 of the year e de cG'o��B�$p pNective.
See �everse side fo� additional instructions and qualffications.
GIBSON COUNT'�
Applicant
Taxing
Assessed value oi real property as of
March 1, wrrent year
If no, what is his / her exact share of interest?
name on record is different than that
of mortgagee or contrad seller
on ieverse
Key n�mber / legal description Record number ��
a�-�a-��-ao3-ob3.s� a�enumber �o'�%a'
Mortgage / Contrad indebtedness unpaid as of Is the appliqnt the sole legal or �
March 1, curr nt year owneR ❑ Yes ❑ No
�1 V�(�l 1
indicate below:
Address of moAgagee or contrad seller (number and street, city,
Name of assignee or other owner or holder of moRgage
of.assignee (num6erand stieet, city, state, ZIP code)
If owned wilh sameone other than spouse, indicate with whom.
Does applipnt own property in any other I If yes, what county7 What Taxing Distrid?
county in Indiana?
� (0 2- JNTY AUDITOR
Deductionap, Dra�verNO. 0 �,-„b..
�
20 _¢�
Signature
Card NO . .....................
County Auditor
zo
❑ Real Property ❑ Mobile Home (IC 61.
Has this dedudion been requesled on
property for wrtent yearl � Yes ❑ No
Fz�
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We certify under the penalty of peryury that the above and foregoing information is We and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person auihorized b�
or by IC 6-1.1-12-.07
executed Power of Attomey
Full residbnf addresS of applicant i �Address of authorized person