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STATEMENT OF MORTGAGE OR CONTRACT IN�EBTEDNESS
id�= FOR DEDUCTION FROM ASSESSED_VALUATION
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� State Fortn 43709 (R6/ 5-06) ' ' ' ` �
� Presrnbed by Department of �onl Gwemment Finarwe �
INSTRUCTIONS:
To be filed in person or by mail with the County Audito� of the county whe�e lhe propeRy is located, D� 1 2���
Filing Dates: 1J Real Property.� Dunng lhe 12 months befo2 ,lune 11 of the year the deduction is to be e�chv .
2J Mobile Homes assessed unde� 1C 6-1.1-7: Between January 15 and Ma�ch 2 of the yea� the deduction�to be eflecfive.
See reverse side fo� additional instructions and qualifications. ' �a�U. �
GIBSON COUNTY AW�TOR
Applicant (ovmer tract uyer- see
(
Tauing District
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Assessed value of real property as of
March 1, current year
16 no, what is his / her exact share of interest?
If name on record is different ihan ihat
of mortgagee or contrad seller
on reverse side)
Key number / legal description '
aG-ia J�aol��.
number
number
Mortgage / Contrad indebtedness unpaid as of Is the applipnt tFie sole legal or e
March 1, currenl year owner? ❑ Yes � No
�p�00�
If owned with someone other than spouse, indicale with whom.
indicate below:
Address of mortgagee or contraIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sheef, dty, state, ZIP
Does applicant own property in any other I If yes. � "axing District?
county in Indiana? � �
v: •' �y,� 2• i��
r� v ,!.•-n'� ��J .JITOR
Deduction approved in the ���e` •' ��'JV \ �
�` �� � ,�
a.
zo r��, i zo
II
Signature
2o I zo
County Auditor
� Real
❑ Mobile Hane pC 61.1-�
�%-c.�o 9- 2 z a
Has this deduclion
property for curcent
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za
iesceo on
Yes� No
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and thal 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
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