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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
SUte Fwm 43709 (R6 / 5-06)
Presaibed by Department of Laal Gwemment Finance
Count Township Year
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�NSrRUCrioNS: �� � � - AUG 1 6 �(�lrlia�
To be filed in'erson or by mail with the C�untyAu�it�� ot the county whe�e the �opert, ' c e.
Filing Dates: 1) Rea/ Property: Dunng the 12 months betore ,lune 17 of the year e deduction is to be e� � �Q
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the yea� th�duc�is to be el%ctive.
See �everse side /or additional inslructions and qualifrcations.
GIBSON COUNTY AUDITOR
Taxing
Assessed value of real property as of
March 1, cunent year
If no, what is his / her exact
Key number / legal des 'ption Record number
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Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ' � Yes' � No ' y
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name on record is different Ihan lhat of applicanl,
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Signa
of mortgagee or contrad seller
below:
If owned with someone other than spouse, indicate with whom.
of mortgagee or wntrad seller (number and street, city, state, ZIP
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a �°�- �.��y
Is the property in question:
❑ Real Property ❑ Mobile Hane OC 61.
Has this dedudion been requested on
property for wrrent yeaf? 0 Yes� No
2�
Date
20
We certify under lhe penalry of perjury thal the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
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Full resident address of applicant
70 � N Co�-P `�x..�.„.� �e1
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address ofauthorized person