Mortgage_Wann""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun Township vear
FOR DEDUCTION FROM ASSESSED VALUATION
Stata Form 43709 (R70 /11-08)
` � P(escnbeO bY �Mnent d Loraf Gwernmerd Finar�
/NSTRUCTIONS:
To be filed in person or 6y med witlr fhe CovntyAudifor d the county wfrere the property is located.
Fil"mg Dafes: i) Real Property: Must Poe dunrrg fhe yeer for which fhe deduction is soughL J U N� ��(� (�p
2) Mobde / Marwfactured Homes not assessed as Real Pioperty: Musf file dunry tlie hreNe (12) months be�we A1 o A�JtJf yee.
Ne deduction is saight.
See reverse sida for add,lional instru " aM qualificatians � �
AppGCar�i (o»m m�frad dya� - seo m rewrm slde)
GIBSON COUNTY AUDITOR
Taunp Dis4icl KeY mmbe legal des�xi lio
�'�l_ 12_, 2'_ UiPt �_ l�nr� �� I .ii� � R�l�� � i�ii�
����
Y�
tl tq. what ia his / her exarl shara d imeiastt
Y rema m racortl is S�erarrt than ihaf ot acoGO�q. "viEi�ala
unpaid as d Mortgage I Canhad indehtednass unpai0 aa d Is lhe appl�nt"Ihe sda
� date of appfitation �agal n ea�abla wmeR
❑ Yes ❑ No
7 owned wi1M1 Someone olher Uwi SPa+se. indxatB with M»m
Is Na poperty in Quasiim: MnuaOy Assessed
.: .. ... • Real PruPeAY Q MniaiyF�ssessed
Name d monga9ae ar mrtrxt seAa �/�
nadress d rtor�agee «mmraa seoer (m,wei and s�cot �: stata a,o zw cmo)
Name d assigree ar aiher owner a holdm d matBa9e
n�-��,���� �io...�Q0.9......
Card \O. ...�'�o�t,cS,..........
� '1l�� 500. 00
Dae^ aPM�t awn poperty in arry alher I H yes, wha� �
cauMy in IMare?
❑ Yes ❑ No
Dedudim aGGmved'm Ihe artrount d:
20 � 20 20
n baen rapuesled on D�M
❑ Yes ❑ No
20 � 20 � 20 � 20 _
�nalure ol Courrty AuEibr I Caun�Y I Data (rtnnlh. EaY• Y�7
1/ We certify un0e1 the panalty of peJjury Iha[ fhe above and foregoing'aitortnation is true and corteG anC Iha� fhe apptirant is a fesident of Indana and
avner / mntrad buyer of Ihe aforementbned property on date applicatan is filed.
�naWr�(ol1nds fiIDfiame) r/1 / n _ \ Date (rnuuh. day Ycar)
sl�oat,
/�T<I
daulhaizedperson (nwnberanCStreol,pty,sbto,anOLPwtle)