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d�^a STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Count
f__. � FOR DEDUCTION FROM ASSESSED VALUATION
Y�r Sca:e Form 43709 (Rit / 6-09) Gibson
•��r• PrescnbaE by Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail.
Filing Dafes: 7) Real Pmperty: Must be comdeted and daled in the calendar year lor which fhe dedocfion is sough�.
Musf be filed with the County Audimr o� County Recorder of the county where the pmpeny is locafed
on or before January 5 of fhe immediately succeedim� calendar year.
2) Mobile / Manufactured Homes nof assessed as Rea/ Property Musf !i!e with �he County Au0i1w ol Ne
counry where the property is bcated dunng the hvelve (72J mon(bs belore March 37 01 each year the
deduc(ion is sought.
See reverse side 7or adtlifional insfruclions and quali(ications.
Apd�nt (owner ai wntract buyei - see rasbicfiuns on reverse vde)
Mary L Stunkel
Tazing Dis(rid
Haubstadt Town
Asswsed value d real pope
hW�ch t. arrentyear
� S179,800.00
If no. what is his / her enacl
;ey number / legal CescripUOn
2678-36-402-000.382-009
aurent year
name on recard is Gi'erent Ihan that of appli�anl, indicate bHVx:
Michael R and Lynne M. Melchior
Name of mortgagee v contract se0er
FiRh Third Mortgaqe
Atldress of rtwrtgagee or conVacl seller (numbe� antl street. ciry, sfefe, and.
5050 Kingsley Dr, MD #t MOC BQ, Cincinnati, OH 45263
Name of assignee or aNer owner w tqltler ot morigape
r�fy. 5ate. antl ZlPcode)
az
eate
Township Year
�
( 012
Fil a
Form fde_d vnth:
LV'�C��CY��1�. �
p.�. rder ..
GIBSON COUNTY qUD170R
»N number Paae number
unpaid as W I Is the appicant ihe sale
legal or eQUitade awnM
Q Yes ❑ No
If owned with 5omeone oNer lhan spouse. irMinte wiN whom
Is the property in question: Mnuatly,455essed
❑� Real Property ❑ Mnualy Assessed
f Does aDW��nt awn pmperty in a�y oNer / I 1/ yes, what county? I Yfiai Ta�ing Disirict? I Has Nis Gcductbn Deen requesteE m p�operty I
��u��Y N����� n Yes Ly NO fw anent yeaR
❑ Yes ❑ No