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�es '� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�+�; FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
'. .. _ .1 S�ate Fortn 43709 (R6 / 5-061 . � " � . � , . , � . . .
� Prescnbed by Oepanment of Lopl Govemment Finance � � � -
INSTRUCTIONS: ' � � �il Ma
To be filed in pe�son o� by mail wdh the County Auditor of the county where the propeRy is I at d.
Filing Dates: 1) Real Property: Dunng the 12 months be/ore ,lune f 1 0/ the year the deducti�o� � ve.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the�ga� tire ded�rPn is to be el%ctive.
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See reverse side for additional instiuctions and qualifrcations.
Appi n wner or ntr�t buyer- see restnctions on reverse side) � -
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Ta�cing D trid Key number / legal description I
i
� ae-�3-�4���.��-0.
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of
March 1, current.year March 1, current year
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If no, what is his / her exacl
' �
name on record is different than that of
mortgagee or contract seller
below:
GIBSON COUNTY AUDITOR
:IIUIIIUGI ♦ / ��
C•j
Is the applicant the sole legal or
ownef? ❑ Yes ❑ No
IIf owned with someone other than spouse, indicate with whom.
Address ot mortgagee or contrad seller (numbe�(�nd street, city, state, ZIP
V
Name of assignee or otFier owner or holder of mortgage
(numberand st2et, city,.state, ZIP
Does applicant own property in any ofher I If yes, what county? What Taxing Distrid?
county in Indiana? - _ _ __ _ _
Deduction approved in
zo
Signature
amou
�
Drawer NO...�.%,-, y,�a. � �
Card NO . ...........:�
County Auditor
Is the property in questian:
❑ Real Property ❑ Mobile Home (IC 61.
Has this deduclion been requested an
property for curtent yeaRQ Yes� No
Zo
Date
20
We certify under the penalty of peryury 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
� w�a�wcu� a�wo��yu'p/Nnwn� �Hoaress or autnonzea person
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