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"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fwm 43709 (R11 / 609)
, � Presaibed q' DeparoneN of loW Govemrtrerrt finance
m.
e a
wsrRUCnoNS:
b 6e filed in person w by mail with the CountyAUditor or Counry Recorder of the county where the pioperty is located. �"� '
F7'mg Dates: 1) Real Property: Must file tlunrg Ne year for which the deduction is soughG nry rtor
2) Mobile / Manulactured Homes irot assessed as Real Pruperty Must file dunng the fweNe (12) monfhs 9
6etora March 37 of each year the deduction is srought. ��Y �
See reverse ' e foradtlitional insWClions and qual,ficatao s. •
App&ant( orcontraC6uyer-see ' �re
�-- GIBSON couNrr quo
T' D' � Key number I legal 'p' Rxntd number Pege nu
� _ / _ UUO. �/�_ 006 010// �
Assssse0 vWue d real pinpaty az of Mor(p�g e/ Contract Irdeb ness unpaid as d Mortgage / Contract iMe6teCness unPaid as d Is Ihe eGW��i tha sda
Mamh 1, amnt year Marfh 1. artent ynar date of aPP��� Jjo O legal or eQUitade oxnd?
�� OU ❑ Yes ❑ No
no, xfiat Ls h's / Mr erad shara ol intemst? tl rnmed with somewre other Ihan spousa, hd'rcate Wih whom
tt �artie m feadd s QRlerent Man tl�at o( aGP��i. uWipte 6elmr. Is the propeny in questim: MnuaAy Assessed
❑ Real ProPertY ❑ Armually Assessed
Moble Flare pC 61.7-�
Name of �agee ar mntrad se9c �^
�Y/ ��. / 5'- �--'� , 5'�� 3 ��
AAdress of assignee (numDer aM stree; ary. slete, entl LP cotle)
Does aOWinm v.m pmperry in any olher If yes. what muntyt What Ta�dng DsbiG7 Has Ih'a tletlur�m been repuestetl m Propeity
munry m IMa`a'+ ❑ Yes ❑ No fw wrtent yeaR
❑ Yes ❑ No
COUNTYAUDROR
peDUCVOn app�wed 6i ihe amoum ol:
20 20 20 20 20 20 20
Sy�uuua N Co�mbAUditw _ — — — . _ _.- — - ___ -..._'�
I I We certfy unCer the penalty ot perjury that the above and foregoing n i �y� 1 ii of InEiana arW
amer I contrad buyer of the aforementioned property on date appiicatn D r a��' C' I' � �... ..V. !. �.........
Si9!e4ve (owrers fi1N'reme� � � ' �, I a�.
�en.c� �-fY 1���wvn�. Card \O. ....`�.�.......
u0 msiGent address W a (numbe and stree( state antl Z1P mtle) •. ._..
�0� R 5. l �00� (�n-,�L.a�� ���, �'� &� � Ibp�OC� .�
�,a�m�a��,���r�.a����,.,-;z-o.� � � .. ..
i
Address ot aWtot"ve� person (num6er 3rM SbeeL dty. state. antl ZIP cotle) .