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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R6 / 546)
Presaibed by �epartment of Local Gwemmerrt Finarxa
wsrRUCnoNS: �
To be (iled in person or by mai/ with the County Auditor of the county where the propeny is locatgd',.,
Filing Dates: 1) Rea! Property: Dunng fhe 12 months before ,lune �f o/ the year the deduction is H�e� e�e�i�Qs
� 2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be elfective.
See �everse side for additional instructlons and qualifications. �Q� ��
^ n GIBSON COUNTY Atini7nn
Applicant
Taxing Distrid
see
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Assessed value of real property as of
March i, current year
If no, what is his / her exad share of
If name on
side)
number / legal descriplion � Record number
�%` ��tJ�—%QOLN�• (7 !C%v�umber �/
Mortgage / Contred indebtedness unpaid as ot Is the applicant the sole legal or equ
March 1, curtent year owneR ❑ Yes ❑ No '
7 0�
If owned with someone other lhan spouse, indicate with whom.
that of applicant, indicate below:
moAgagee or contrad selier
of mortgagee or contract seller (number and sheet, aty. stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP a�'
-"� �-���!�•.
Does applicant own property in any othP• " �,.••'
county in Indiana? �� •'
O`^`� �t
Deduction approved in the amo�
��ry��
G`'` ���
�'� 20 _
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County Auditor
� ❑ Real Pmpert
� �_
�_�-� 3.
� District?
�uR
20
❑ Mobile Home (IC 6�7.1-
Has this dedudion been requested on
property for wrrent yeaR � Yes � No
20
Date
20
We certify under the penalty of perjury thai the above and foregoing information is true and corred and that lhe applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
Si�p�ture
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1 _� �
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person