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i�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�1 FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
jJ State Fortn 43709 (R6 / 5-06)
Presaibed by �eperiment of Loral Gwemmeni Finance
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�NSrRUCr�oNS: ,IAN 2 3 2�Oi Ma`r`
To be filed in person or by mail with the County Auditor o( the county where the p�operty is located.
Filing Dates: i) Real P�operty: During the 12 months before ,lune 17 0! the year the deduction is to 6e eflective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the`��� derjc(CG'on is to be eKective.
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See reverse side foradditional instructions and qualifications. GIBSON COUNTY AUDIfiO�
Applicant o er or contracf b�yer ee reshictions on erse side
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Tauing Dis rid Ke number / legal description Record number /
�-!d -�9 -�.� -60Q /Gd -OZ8 �o
� ' .{� D� 9- e� /�a - � Page number �j��
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or f
March 1, current year March 1, current 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 ihat of applicant,
of mortgagee or contract seller
Address of moAgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
city, state; ZIP
Address of assignee (number and st2et, city, state, ZIP code)
Does applipnt own property in arry other If yes, what county? What Taxing District?
county in Indiana?
DPa�\'CI` �'O. ���.:. /../ �� N AUDITOR
Deduction aF
zo �,
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Signature
� 1"d N� . . . . � �E
99, ?�-v . �� �
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County Auditor
❑ Real PropeM ❑ Mobile Horne OC 61.
Has this deduction been requested on
property for curtent year? 0 Yes � No
20
20
We certify under lhe penalty of perjury lhat the above and foregoing information is true and corred and that ihe applicants 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
IAddress of authorized person
DJ �1070