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;ei "� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
{\i� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
`��J State Form 43709 (R6/ SW) � � � ��
�• Presaibed by Department of Lotal Govemmeni Fina�e g"'1 � �
Y
INSTRUCTIONS: Q(,T 1 ����y�
To be filed in person o� by mail wit6 the County Audrtor of the county where the property is located.
Filing Dates: 1 J Real Property: Du�ng the 12 months before ,lune 1 i o/ the year the deduction is to be e/fe � �
2J Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the yea� e de ct i ective.
See reverse side (or additional instniclions and qualifications.
GIBSON COUN� ����
Applicant (owner or confract buyer- see restrictions on reverse side)
�
Taxing Distrid Key number / legal descriplion Record numb
P ' db3 ^�$ Page number
- l- - lb3- t .
Assessed value of real property as of Mortgage / Contrad indebledness unpaid as of Is the ap�
March 1, wrrent year March 1, current year owneR
�a.bb� ..
If no, what is his / her exact share of interest?
If name on record is different than that ot appticant, indicate below:
�
� legal or equitable
❑ No
owned with someone olher lhan spouse, indicate wilh whom.
❑ Mobile Home OC 61.1
of
or contract seller
Address of mortgagee or contrad selle� (number and st2et, city, state, ZIP ��� �
Name of assignee or other owner or holder of mortgage �/v ���� �� P��
Address of assignee (num6erand s6eet, city, state, ZIP code) (� q
�. I � � {��
Does applicant own property in any other If yes, what county? ____„�n been requested on
county in Indiana? property for wrtent yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � I 20 �
�
Signalure
20 20 20
County Auditor
�
20
We certify under the penalty of perjury that the above and foregoing informalion is true and correct and that the appticants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person