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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
: / State Fwm 43709 (RS / 4-03) � .
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� Presaibed by Department of local Govemment Finance
INSTRUCTIONS:
Coun Township Year
MAY Fi�eS��@O6
To be �led in person or 6y mail with the County Audifor o/ the county where the property is located.
Filing Dates: 1J Real Property: During the 12 months be%2 May 11 0/ the year the deduction is to be eNective.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 o(the year the�v�n-t�s`N�e eNective.
See reverse side for additional insfiuctions and qualiTcations. GIBSON COUNTY nUDI70A
Applicant (o� n or nfra f buy r- see strictions on reverse side) ,
�7V� � t�C�./In.�.�
Taxing Distrid Key number / legal description Record number ��
1 w" ' �I /l_ D.a a�:�s-c� Page number �^�
�,� . �
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March 1, current year , ownef? ❑ Yes ❑ No
`7 J V U'� }
If no, what is his / her exac[ share of interest? If owned with someone other than spouse, indicate with whom.
It name on record is different than that of applicant, indicate be�ow: Is the property in question:
❑ Real Property ❑ Mobife Home QC 61.1-�
�me of mortgagee or conlraIX seller
Address of mortgagee or contracl seller (number and street, , state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand sfreet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
counfy in Indiana? property for current yeaR � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount oL
zo �_ Zo �j�_ zo 0 9 zo zo zo zo
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Signature County Auditor Date
W certify under the penalty o erjury that the above and foregoing information is true and corred and that the applicants was / were
r ident of In a and ne of the aforementioned property on March 1, 20
i a e( rs f n Person auihorized by duty executed Power of Attorney
or by IC 6-1.1-12-.07
FuII eOsident d s� a licant � Address of authorized person -
5 _ '�/�/ ' �Y'►! � �