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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
_,. ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R11 / 6-09)
�' ,y. f Presaibed by DepartmeM af Laml Govemmerit Rnance
File Ma
wsrRUCnoNS:
To be filed in person w 6y mail with the CounryAUditor or Counry RecoNer o/ the counry wfiere the property is bcated.
Fifirg Dates: 1) Real PmpeRy: Must file dunng the year (w which the deducfion is soughf. County AudBnr
2) Mo6�7e / Manufactured Homes rrot assessed as Real P`operty Must fiie dunng �he twelve (72) months ���
6efae March 37 of each year the deduction rs swight. u Recwder
See �everse sidelorado'dional instrucrions arMquali�catans. GIBSON COUNTY AUD
Ap nt (owner w contrart buyer- see msbicDxtt m rcva(�
Taz'ug Dis9ict Key number / legal desmption R¢tord number Pa9e nu br1
a�-i3-i3-YOa-oo�_157-ao7 0/ /
AAesseO ralue td real of Matgage / Cantract iMebteCness unpaid as af Mortgaqe I ContrarY iMebtetl�ss unpaitl as of Is Ne appOrant Me sde
1 Nad� 1. anrnl year Mg�m1J� 1hartenQtye�' / date of appGntion legal a equitade mme(?
0'� d, � 7 Y � Yes ❑ No
olinterest?
If nartg on remrA is Eift¢rent Nan
Name ot rtnrtgagce n contraG seqer ^� n
�� K
ACAress o1 �mt9agee w mntrad se0er (nwMer and street, �y, stafi. arN ZIP ood[
Name of assigM.re w othu owner w holder of mortgage
A4dre5s of asvgnee (number end sbee4 mY. stafi. and ZIP Code)
l]Oes appivant o,m poperty
munryinlMiana? �
�o�
D�ucom appmR.d In tlre amount oE
20 � 20 _ � 20 � .
I/ We certify under the penalry of �rjury that tt e�hove and (oregoin
owner I contract buyer of ihe afo�emeMiwied property on date applic
Si8 (o +� rs/� lame) � /
� G�Si-'L% � �IZt� S
F rrsi0en a�dress of a t(numbar antl shee4 te, ZlPCOda)
�� ( 1�� D��S�-, D�c�u�C�lti,
Pelson auitwaed Gy tluty eseartetl Powcr of Attorney rn by IC G7.1-12-0.i�
AtlCress of au4roraed person (num0er aiM sneef, dry, sfate. and LP code)
If awned wiM someone other C
1� U��S
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aoi�
319�
O /�/' J
a�,, � 9 y. ��I
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Y�
Fiort�e (IC G7.
!e0 m prOpPJly
Yes ❑ No
20
nt of IrWiana arM
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