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'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T hip Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
� � �• State Fartn C3709 (R71 / 6-09)
S ! P�ipyd py pe��nl of Local GovemmeM Frence
' Mark
, srRUCnoNS: JUL 3 0
«m Aaa �m:
To be h7ed in person w by maii wiN the CountyAud'ROr o� Counry Recorder o! the county where the property is located.
Filing Dates: 7) Real Pmperty: Must file dunng the yearlor which the deduction is sought C.�. Counry Audimr
2J Mobile / Manufectured Homes rrot assessed as Real Pruperty Must fife dunng the fweNe (12) monfhs
6efore Ma/ch 37 0! each year the deduction is sought County Recorder
GIBSON COUN
See reverse side (or additional instructions and quali�catrons.
am� mlew�rorm�fiadbuver- C ni. /
i ' Disifi // �Y
U
AssessedraWe frea1P�7�Yasoi
MarU 1. axm�t Yrv�
tl no, whe�'s his! her e�a share of intriz
If rwne
/ ContrarY irdebteE�ss unpaid as of Abngage / Contrx['uWebtetl�ss
a„�_..'/__/ dateofaPPlkatian
7 % �� �
� If awneA wiN somearie other than spouse, i
Mat of aPP��l "mduate 6elow.
Name of mortgagee or connec7 seller
�..
Atldress of mw�a9ee w mntraG seAer (�
Name of assignee or oNer avmer w holdi
AOdress ot auignee (number antl atree4
Dces aPpli�ant ovm paperty in any other
nry in �Mana? ❑ Yes
DeducSion aoorwed'ui the amount oE
,�
d Cound Autlitw
�
crty, sfate, anE LP code)
�
. ��
�,`-_
•�
�s
COUNTYAUOROF
Recoid
as d I Is �he apP�t Ne sole
legal w eWitade oxtce(1
❑ Yes ❑ No
Is Me ProPPrtY in VuesUOn: MnuaAy AssesSeE
�.Real PropeM1Y Q Armua�y Assesud
I�MhiIP Hart�e IIC Fi1.1
�
rn�R� uRc, l�E��`' G
�yS7�
Za _ � �
Couny
�a -3� S u � No
� i Zo _
c�. �,-. r�a
I/ We certify u�er Ihe penalry ot perjury Ihat ihe above and toregoing intortnalion is We and correc[ arM �hat the applitant is a resident ot Indiana aM
owner I contract buyer of Ihe aforementioned property on date appfication is fiied.
7�tlue (owr{�fs fiN na Date (month. daY, Yaa�)
��L n rrl ,,.. _ �, e 0 `� _ ��/1 - i �
Person
rity, state, ard
of Attomey ar by
(numberantl sveet. dty, state.
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