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� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
"• � FOR DEDUCTION FROM ASSESSED VALUATION
� . «. �! State Form 43709 (R6/ SO6) � .
Presvibed by Depanment of Lonl Govemment Finance
INSTRUCTIONS:
To be filed in pe�son o� 6y mail with the County Auditor o/ the counfy whe�e the property is located.
Filing Dates: 1) Real Property: Dunng the 72 months be%re June Il of the year the deduction is to be eHecti,��f rJ � 1 20(��
2) Mobile Homes assessed under IC 6-1. 7-7: Between January 15 and March 2 of the yea� the deduct�on is to`be effective.
See reverse side /or additional instrsicGons and qualifications. �j� ��
GIBSON COUNTY AU�i7na
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Key nu ber / legal description Record number
� '^ ' Page number
- I- - 300-�4 -o�
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitabie
March 1, current year March 1, cunent year ownef? ❑ Yes ❑ No
a 33�q�
If no, what is his / her exad share of interesl? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-T,
mortgagee or contrad seller
Address of mortgagee or contrad seller (number and stieef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number an
Does applicant own property in r
county in Indiana?
DI'A{1'CI' l��0..: ��j�
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)eduction approved in the amount of:
20 �� 20 �_ 20 � 20
ti � r
Signature
County Auditor
�
3 District?
Has this dedudion been requested on
property for cunent yeaRO Yes❑ No
20
20
/ We certiy under lhe penalty of perjury lhat the above and foregoing information is true and corred and lhat lhe applicants was / were
resident of Indiana and owner of the atorementioned property on March t, 20
Person authorized by duly executed Power
or by IC 6-1.1-12-.07
of �pplipnt ,� �Address of authorized person