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""+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION �
State Fartn 93709 (R71 / 6-09)
, w�. � Prewi6eE by DepartmeM of lnW GwemrneM Fnance
File Mark
INSTRUCTIONS: OC .
To 6e filed in person w by mail with the CountyAWitor w Counry Recorder of fhe counry where the property is bcafed.
FiNng Dates: 1) Real Propeiry: Must file durirg the year fir which the deduction is soughL Coun Auditnr
2J Mobde /Manufactured Homes rat assessed as Real Property: Must file during the tweHe (12) rtronths �—� � �/1 �•ry R
before March 31 of each year the deduction is sought. ��f'" �UPry ecorder
See reverse side 7or adddional instrucUons errd qualfications. GIBSON C
�,. AppGc�t (ox*rer m corvrarl6uyer' seqiesL'r',to2s 9ff�everse sde)
Key num6er I legal desaiption
�/o -/9. _��_
If no. what ¢ his / hu e�
If rarte m remrE e 6tfere�n than thaf ol aPP�• h�Giate belmr
Name ot rtnngagee or mnvaU se0er �/�
Addren W mort9a9ce a cantrae se0er (numbr.r a meeG �'. stam.
smte, and LP code)
Does appFrant arn propelty in any aher (/
county m Intliana? ❑ Yes
❑ No
Deduction approveE in Me amount of.
M yes, what munt�?
20 _ � 20 _ � 20
��
1/ We certify unc�f the penal
owner I mntract �ure� of the
resident adEress of app�Kani
Reco number Page num6el
70. '-/�7 -00 0I0 D �
es of Mortgage I ContraG'vWe6ted�ss unpaitl as o( Is Me ePd�t ihe sda
Cate of appfrcetion legal n eQUBade mmrY/
❑ Yes ❑ No
awned wiN :nmeo� aher than spouse. 4Nkate uith whom
Is O�PertY in puestiu� MniaDy Ass¢sed
Real ProPeKY ❑ ��Y �
aa-9 a3a
NTat Taring D' 'r1? Has Ihe dedufSm been
for ou�e+v YraYT
20
the above and toregoing infamation is we :
property on date application is filed.
c'rry, sfate,
�,I)
lddress ot auttv'ved D�son (numbe� a�G sbee( ri�: sbfe. and LP oodei
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y 7 6�9
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