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"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�_... .� FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (Re l 2-07)
�' ,.,, � R�srnbed by Department of Local Govemment Finance .
F' ark
INSTRUCTIONS:
To 6e filed in person or by maa with the CountyAuditor o/ the coun[y where the property is located.
Fding Dates: 7) Real Property: Dunng the 72 months belore June 17 0/ fhe year the deduction is to be eBecGv� U N 1� 2� 0�
2J Mobde Homes assessed under IC 6-7.1-7: Behveen January 15 and Maich 2 0/ the year the deduction is fo be eAective.
See reverse side for add6onal insWctions and quali�icatrons. `�y� �,(� .
n �/ [� ���,
npp' nt(o rorw c�nuyer-seeres7ic onreversesi GIBSON COUNTY AUDITOR
1� _%°�i"_ , i�'� S � t �_.
Ta�d 'slrid / Key rwmber / legal tlesmp4
1
ll..
A4essed value oi real popaly as of Maich 1, arrent year Mwtg
wRen
1' vhat is his I her exacl share M inierest?
�-
If nvne m recortl is d'Atarenl ihan Ihat of applicant, iMiple below:
Namea(mm19a9�o��^�� ' / / (
Address af moAgagee
sheef, dty,
Nama of assignee a dher oxrrer w hdder of matgac,�e
Address ot assignee (num6el arM sUeel. rity, state, aM ZIP code)
Does applicant ovm property in arry dher If yes, wh�
caunry in Indana?
❑ Yes ❑ No
Deduction app�oved N Ihe amaunt OI:
20 � zo _ zo _
j'`iL (JUO. 07��� �O �
Contract indeWedness unpai0 as of March 1,
legal a equifade wmcYl
❑Yes ❑ No
someone dher �han spouse. indrate wilh whom.
WhatTa�dng C
Is Ihe proper(y in question:
❑ Real Propertv ❑ Mobile Home
• •. n � �n .
.. ' Dra���r i�TooWQZ:.�i�18�
COUNTY AUDfTOR �
.. 8I'(� �� � . ..............
�u I - ���/GG GuG. oo _
oa�e
I I We certily under the penalty of perjury ihat the above and foregoing infomwtion is We and cortect and Uia[ tl�e applinnts was / were a residenl of
Indiana and ovmer of ihe afwementioned propeAy on March 1, 20
�rylu�e (owners hnneme) _ . �ate (month, oar r��
cdy. state. aM
f _nr" ��(�39
Prlmn aulhor¢ed by duly erzecvted Power of Attomey or by IC 61.1-12-.07 Oate (��. daY. Y��)
Address of aulMrized persa� (num6ei antl sUeeG aty. s(afe. arrd ZIP rode)