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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�'+ w� ! State Fwm 43709 (RS / 4-03)
PrescnDed by Depanment of Local Govemment Finance
�
INSTRUCTIONS: ���� File Mark
To be filed in person or 6y mail with the County Auditor o/ the county where the property is lo�. yp�
Filing Dates: 1J Real Property: Dunng the 12 months be%re May 11 of the year the deduction to b�@ ffective�—j
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the`y�arMc�dedurlio is be e(fective.
See reverse side for additional instructions and qualifications.
Disirid
ons� rev e s�
Key n mber / legal
JUN 1 2 2006
GIBSON cni n�r
I Record number
Page number
Assessed value of real properly as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitabie
March 1, cunent year � March 1, wrrent year owneR ❑ Yes ❑ No
If ,io, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate beiow: Is the property in question:
� Real Property ❑ Mobile Home pC &1.1-7�
of mortgagee or contract seller
Address of mortgagee or wntrad selier (number and 5t2et, city. state, ZIP
Name of assignee or olher owner nr holder of moAgage
Address of assignee (number and st2ct: city, slate. ZIP code)
Does applicant owo property in any other � If :��.�; �•�hat counry? bVhat Taxing Distrid?
county ir Indiana?
COUNTY AUDITOR
Deduction approved m the amouvt nt:
zo.�2 Tz� �_------ ro 9 q_ zo _.
I � �
_�--..-- -----�-------�- —
Signature __ _ County Auditor
�
�%x �o /— �% 8�f
Has this deduction been requested on
property for wrrent yeaR � Yes� No
20
Date
zo
We ce�tify unAer Ihe p,�nalty of per;� �r� rhat thP above and foreaoina fnfonnalipn is hue and corred and that ihe applicants was / were
�esi6ent of Indiana and owner of th? afnrementioned property on March t 20 __
; d:
Person a��thorized by duly exewled Power of
or by IG 6-1J-12-.07
resident arid��✓of ao�cant � /— 'Address of authonzed person