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^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
= FOR DEDUCTION FROM ASSESSED VALUATION
`r' _ ' • Stata Fortn 43709 (R71 / 6-09)
S I P�esui0etl M�D��rd of Lo� Governmerit Firarre
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NsrnucnoNS:
To be lled in person a 6y mail with fhe CounryAUd"ROr or Counry Recorder of the owinty where the property is located. ��� "ti'2 � � �
Fding Dafes: i) Real Properry: Mus! file durirg the year for which the deduction is sought. � n County Auditor
2J Mo6ae / Manufactured Homes rrot assessed as Real Property Must Ae durirrg the twelve (12) rtanths ^r`''i
6efore Mamh 37 of each year tAe deduction is sought. LJ � ��
SeereversesidelwadditionalinsVUCtionsarMquali�cations. � `�� /� GIBSON COUNTY AUDITOR
MP�nt(oir�aroontrart6uyer-se�esLrtbrao�rreversevdg � fl . /1 II . e
MaRh 1, qrtml yP2r
II ro. what I5 his l her erafl share ot interesi?
If name on �ecorC a Giflerent Nan ihat ot apPli
Name of mort9a9ee ar trntract seller
� i°i�=�'eo - 000. ��ta-a�b .
� rnMMqage / Contract'vitlebtetlr�s unpaid as of Morigage I Conf
� Marrh �, a�t rmy da�e or aPprKat:
w mntrad se0er (number ard street, ciry,
or oNer owner rn hdder M mort9age
AECress ol asvgnce (num6eraM streel, c% s/ate.
Dces aPWicam wm P�P�Y
fv,my io inaena? �
ap�w.ea m tice amount ot:
zo_ i �
(,J�LI�1'7�, (�us��
K �zsror�e a
ll - �5s�
mrtieone other ihan spouse, i�icata with wlwm
appfxant tlie sNe
w eduilable owne/�
❑ Yes ❑ No
Is Ne property in puestion: Mnually AssesseA
❑ Real Roperty ❑ Armualh� Assrssed
� I Mas Nis dedupion Deen re7uested on P�Y
1 for wrtent yeaYl ❑ Ye5 ❑ No
��.
_ � �
�
� „�,. �Y,��
I/ We certfy under ihe penalry of perjury that the above arW (oregdng infortnatlon is W e and correa and Nat Ne applipnt is a resident of Indiana aM
owner I traci buyer of the aforementbned property on date appiiration is filed.
y�dre ers n,o rema) . _. n// • oate (monm. ear. r�h
slafe,
Person auNaaeE Dy Auh/ ezecutetl Power W AttaneY a M IC G7.1-12-0 7 I Date (rtronM. day, yea�
AEAress d aW�ttrsed person (numberaM sbee{ riry. state. aM ZIP oode) .