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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' � FOR DEDUCTION FROM ASSESSED VALUATION
S J SlatE Form 43709 (R4 / 10-01)
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PrescnbeA by DepartmeN of Locsl Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ lhe county whe2 the prope�ty is located. 2UO3
Filing Dates: 1) Real PropeRy: Dunng the 12 months be%ie May 11 0l the year the deduction is to be efles�� 9
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 0/ the/ y�ear the deduction is to be effe/ctive.
See reverse side (oraddifional instructions and qualifica6ons. K�L�i�� �� I�
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�' GIBSONC'�OUNTY AUOITOY �
Applicant eror ct buyer- see res 'cti ns n reverse side)
Taxin rid Key number / I al escription Record number `�
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/ � ( � ��( � Page number �� , f /
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Assessed value of real property as of MoAgage / Contrect indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interesl? If owned with someone other lhan spouse, indicate with whom.
If name on record is difterent than that of applicani, indicale below: Is the property in question:
❑ Real Properly ❑ Mobile Home QC 61.1-�
me of mortgagee or contred seller
Address of mortgagee or contract seller (numb r and st2et, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, sfate, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent yea(? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
Zo �,� zo 0 zo �� zo.� 20 � zo �_ zo 09
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Signature County Auditor Date
' e certify under the penalty of perjury that the above and foregoing information is true and corred and that ihe applicants was / were
sident of Indiana and owner of aforementioned property on March 1, 20
Signature w rs full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
11 r' ent addre f a i t Address of authorized person
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