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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R4 / 10-01)
Prescribea by Department of Loral Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county where the property is located. � t tS � 9 ��01
Filing Dates: 1) Real PropeRy: Dunng the 12 months be(ore May 11 of the year the deduction is to be etfective:�
2) Mo6ile Homes assessed under IC 6-1.7-7: Behveen January 15 and March 31 of e year the duclion is to 6e eHective.
See reverse side for dd' ional instructions and quali�cations.
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� n�. I� _.�K _.�.I M /'V'�/� /lQ"� .n.. f�. GBSON COUP`�TY AUDITOR
(ownerorconfrac uyer- see resItncfions on reverse side)
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Taxing
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Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exact share of
Key number / iegal
Record number Q Q
Q O -�� Page number _/�O_9, /�� �
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Mortgage / Conlracl indebtedness unpaid as of Is the applicant the sole legal or equitable
March current year owneR ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
name on record is different than that of applicant, indicate below:
of moAgagee or contracl seller
Address ot mortgagee or contred selier (number and street, city, state, ZIP
Name of assignee or
Address
owner or holder of mortgage
(number and street, city, sfate, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing District?
county in Indiana?
Deduction approved
20 (,'
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in the amouni of:
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20 � 20
COUNTY AUDITOR
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County Auditor
❑ Real
❑ Mobile Hame (IC 61.1-�
Has this deduction been requested on
property for current year? � Yes❑ No
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certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
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Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
person