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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNEgc
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortr 43709 (RS I 4-03)
Prescn�ed by DepartmeM of Local Govemmem Finance
INSTRUCTIONS:
To be filed in person or by mail with the Counry Auditor of the county whe2 the property is locate�.�� �
Filing Dates: 1) Real Properry: During the 12 months belore May 11 0l the year the deduction is e�iv�D03
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March o/ the year the df duction is fo 6e efFective.
See reverse side tor additional ins[ructions and qualifrcations. /7[/
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GIBSON COUNTY �R pi7'��
Applicant (ownerorcontracf
Distrid
Assessed value of real property as of
March 1, cunent year
If no, what is his / her exacl share of inlerest?
on rev se s�d )
� �.��n�-'i� "-c- " " v �
iumber / legal description Record number
d /S _O/�3S -�
MoRgage / Contrad indebtedness unpaid as
March 1, current year
If name on record is different lhan that of applicant,
of mortgagee or contrad seller
below:
Page number
is me appucan� me soie iegai or
ownef? ❑ Yes ❑ No
� I
If owned with someone other lhan spouse, indicate with whom.
Address of mortgagee or conlred selier (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state,
s the praperty in question:
❑ Real Property ❑ Mobile Hmie pC 61.1-�
Ooes applicant own property in any ofher If yes, what county? What Taxing �-'°duction been requested on
county in Indiana? Dt �'^�aar?�] Yes❑ No
awerNp v> �
cour,n,auo�ro cardNO. �'�P��:
Deduction approved in the amount of:
20 � I 2� �� I 20 �1� I 20
Signature
County Auditor
20 �� 20 =
� P
Date
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
ient of Indiana and awner of the aforementioned property on March 1, 20
(owners
applicanl
�
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person