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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stale Pofm 43709 (R4l 70.07)
PrescribeC by Department of Local Govemmen� Finance
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INSTRUCTIONS: , Fjle, Mark
To 6e filed in person or by mail with the County Auditor of the county where the property is located. I"IAIC 1� 1003
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0( the year the deduction is to be effe 've. -
2) Mobile Homes assessed under IC 61.1-7: Behveen January 15 and March 31 0/ the year e deductio is to%be effective
See 2verse side /or additional instructions and quali�cafions. ` J7 /
� GIBSON COU�TV q�iD!TOR
Applicant (owner or contract - see restrictions on rev�e side)
Taxing District Key number / legal description Record number
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Page number
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wrrenl year owne(? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that ot applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobiie Home (IC G1.1-�
�eme of mortgagee or contrad seiler
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applipnt own property in any other If yes, what counry? VJhat Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent yeaR � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Dale
'/ rtify under the penalty of perjury that the above and foregoing infarmation is true and corred and lhal lhe applicants was / were
sid nt of Indiana and owner of ihe aforementioned property on March 1, 20
.
gn re ( ners (ull name) Person authorized by duly executed Power of Attomey
) or by IC 6-1.1-12-.07
esidentOadd s of ppli ^, /� ��� Address of authorized person
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