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.a °'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION �� �
State Fortn 43709 (R8/ 2-07)
�' y�• r Presaibed by Depaitment o( Loral Govemment Firance /�, �
V\n
INSTRUCTIONS: ,'� JUN ��e �$
To be filed in person or by mad w'rfh the CountyAuditoi o7 the county where the pmper(y is bcated.
Fding Dafes: i) Real Propel(y: Dunng the 12 months be%re June 71 0/ fhe year the deduction is to be efiecfive. �
2) Mobiie Homes essessed under IC 6-7.1-7: Behveen January 15 and March 2 of the year Ue deduction is to�
See /everse side !or additbnal ins6vctions a� qualifications. �
GIBSON COUNTY AUDITOR
Aml(c�rh (ownei or wnLaC buver - see✓e9rirlims m ieverse side) /l , . i
1 Key number/leyal cnpUon �Qp�' .OQ �/ -(�� Remid number Page number
��- a-�o - i - aoo -� �-�o � oo � 3 J
,e of real popaly as d Mamh 1, ament year MMgage I ConVad iiWeWedness unpaid as of March 1, Is ihe appGcant ihe sde legal or equita6le wrt�ell
curtenl year
DO �O� ❑Yes ❑No
ha / her exacl share af inleres�? I( owned w�h sortieone oiher lhan spouse. i�cate wiih wMm.
I( reme on recad
rmt�gagee or canLact seller
Address of mortgagce «mntrad seller
Name of asagriee a athnl owner or
/�:R:'ii
lirant rnm poperty in arry dher
Indiana?
❑Yes ❑ No
Deduction
�
i4�7
I/ We certify under Ihe p
Indiana and owner of ihe
auUwraed by duly
of:
applicanl, indi�le below:
�
number arM 5 C dty, state, aiM ZlP cro0e)
er of martgage
dty, state, aM ZIP code)
It yes, what counry?
20 � 20
Real Property ❑ Mobile Home QC 67.1-7)
,.w s.z�a
IV B
��"'���'�
���8'I(� .�/� ���U GOO. o0
20 _ � 20 _
�tetl on propBrty
� Yes ❑ No
Oate (rtemlh, day, yea�
i
ihat Ne above and foregoing infortnation is trve and cortect and that the appli�ants was I were a resident of
property on March 7, 20
�� Date (rtKanth. daY• Y�A
stata.
w by
Address of aulhorae0 persm (num6ei arM s7eeG dty, state, arM LP mde)
Dale