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.•.�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
� FOR DEDUCTION FROM ASSESSED VALUATION I
.',� Stale Form 43709 (R8 / 2-07) J�'
���;y,. '� Presrnbed by Depahmenl of Local Govemment Finance
f�(
INSTRUCT/ONS:
To be filed in person or by mail wRh the CountyAuditor o/the county wheia the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months bafore June 11 of fhe year lhe deduc6on is to be etfecGve. �%a��i�
2J Mobile Homes assessed under IC 6-7.1-7: Behveen January 15 and March 2 0( fhe year fhe deducfion is t eA e.
See 2verse side /w addilional inshuctions and quali�cations. GIBSON COUNTY AUDITOR
Applicjht (pwnei or mnVacY 6uyer�ee rcstry�lipns on r�/eVsy side)
Taurg Di Uid Key number / legal desaiptbn Record num r Page number
a2lo - - l b'- a-� 3- vo.8 1 6- o0 0
hssessed value of 2al s of Maich 1, auient year Mortgage / ConUad i�eEtedness unpaid as of March 1, Is the appGpnt ihe sde legal w equifade oxneYl
wnen� year
Sd ��� ❑Yes ❑No
wtwl is his I her enacl share of i,rierest? If amed wilh sameone dher lhan spouse, indicate wiih whom.
�
If reme m recwd is dfierent Nan U�al of applrcant, indinle belaw: Is Ihe property in Question:
❑ Real Property ❑ Mobile Home QC 61.
Name of mortgagce or conLacl seller
AdEress of rtroM1gagce a oonUaG seller (i
Name of assigrree w other owner or hdde
Atldress of assignee (num6uaM sVeet.
Does applicanl own property in any other
counry in Indiana7
❑Yes ❑ No
Deduc6on approved in the amount of:
2b
I/Wec
Indiana
�
ntyAudROr
nder the penalry
owner of the afore
s hAI name) /\/I
�er anJ streef. tlty. 5afe. anO ZIP code)
martgage
stafe, arM ZIP oode)
It yes, whel caunt)?
COUNT
20 _
,�'i��
C� n��� �� _..._.,_''�,reauestedonWWanY
!��/7/WGY S�/�Nit%p,tJ a Yes ❑No
//
O/ Bf �
ume �,,.,.._.. . ee�}
20
that the above and fore9oing infortna6on is We and cortecl and fhat tlie applicants was / were a resident of
property on March 1, 20 _ __
aM Z!P
�
Person authorizetl by duty execuled Power of Pttomey w by IC
person (numbei aM sfreet. pty. sfafe, aM ZIP mEe)