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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (RS / 4-03) �
PreSfiiEed by Department of Lotal Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months 6e(ore May 11 0/ the year the deduction is to be e�i$✓e() 4 Z��S
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. "�i� ��
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GIBSON COUNTY AUDITOR
Applicant (owne ra b er - see sfrictions o everse �
Taxing Distrid � Key number / legal description Record number
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������ /�/ / �O O � �� � Page number �,,. /
,C/ J y
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, cu� t year owner? ❑ Yes ❑ No
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It no, what is his / her exact share of interesl? _ owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicanl, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horne QC Et.t-�
�me of mortgagee or conireU seller ��
Address of mortgagee or contrad seller (number and st et, dty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (nw � "° �e) _
Dra►ti.er �,p, --- .
Q,� ^ ..� ('
Does applicant own pro� '�.�`" iat Taxing Distrid? Has this deduction been requested on
county in Indiana? Card i1'Q. �� property for current year?� Yes❑ No
�Sj?5'��� .........
UDITOR
Deduction approved in the amount of:
20 �! _ 20 � 20 �_ 20 i 20 20 20
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Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners II name Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ly I resident addres of a plicant Address of authorized person
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