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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ s FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 63709 (R71 / 6-09)
�' 1 Presvibed Dy DepartrtreN of Local Gwemnrent Firence
�r.
File a
lNSTRUCTIONS: �,,�^ Y
To be fi/ed in person or by mail witA Ne CounryAUditor or Counry RecoNer o! fhe counry where the property is locat�'
Filirg Dates: 7) Real Property: Must file during the yrear Por which the deductlon is soughf.
2J Mobi7e / Manufactured Homes not assessed as Real Property: Must fi/e during the hveNe (12) morGbs��
befae March 37 of each year Ne deduction is saght.
See 2verse siCe for addifional instruUians and qualifirations.
App�i�bwner orcontrart buye� - see resvictior� m reverse side)
������
1. bnart �2dr
whaf is his / tcer exaG share o( interest?
- �3 - a 9 -io
utgage / Conbaa intle6teCne
vch 7, wrtent year
400D
It rwne on 2md is diRerent ihan Nat of app6rant, vmEicate Debw.
Name W mvtgagee «mntrxt se4er �
Address o� nartgagee w contract seller (num6rr and sbeet, cay, stete, aM ZIP coda)
Name o� assignee or � rnmer w lwlder ot rt�ortg�e
(number aM sbee; tlry, slate, and LP tode)
NE ti►w a9-�.-
uopeM1y in any other If yes, what wun1�R
County Auditor
Counry Remrder
GIBSON COUNTY AUDITOR
r
Record numE� Page numbrs
ao .3 - oo /
1 as d Mwigage Contra� 6Webiedness �mpaid as d Is ihe appWant Me sde
date of appfrcation legal «equita6le wmeYl
❑ Yes ❑ No
tl owned wi�h someorie dher than sG��. ind'xale wiM whom
Is Ihe pmperty in QuesGm: MmWly Assessed
� R221 PloPertY ❑ �Y �
Mable Fiune pC 61.1-�
2t�-f�Ga�� /}�DiJ / ' m0 f.�:�/ ---
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c_n.%L�+- C,
a. y3A � �-I(cul
VJhal Taring Disvic[?
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