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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S�ate FOm143709 (R4 / 70.07)
PreSCribeO by Depanment of Local Govemment Finance
Count Township Year
1NSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor ol the county whe2 the property is located. �"�AR 1 3 2��2
Filing Dates: 1) Real Prope�ty: During the 12 months 6elore May 71 of the year the deduction is to be eflecfive.
2) Mo6ile Homes assessed under IC 61.1-7: Behveen January 15 and March 31 of e year the ed�ion is t be ffective.
See reverse side tor additional instructions and qualifications.
GIBSON COUN i Y AUDITOR
r+ppucam �owne� or contract nuyer - see 2smchons on reverse sfde)
Taxing Dislrid ey number / legal de
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Assessed value of real property as of Mortgage / Contract i�
March 1, current year March 1, current year
If no, what is his / her exact share of interest?
If name on record is different than lhat ot applicant,
of mortgagee or wntract seller
below:
Record number
Page number
unpaid as of I Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
If owned with someone olher than spouse, indicate with whom.
Address of mortgagee or contrad selier (number and st2ef, city, state, Z!P
assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Is the property in questian:
❑ Real Property ❑ Mobile Home pC Et.
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year? � Yes � No
20
approved in the amount of:
20
5
COUNTY AUDITOR
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County Auditor
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20
Date
20 ( .P� ��
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certify under the penalty of perjury lhat lhe above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person