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"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
,. , FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fwm 43709 (R71 / 6-09)
� Presmbed EY �^� of Ln�al Govemmerrt Finarr.e
�«.
INSTRUCTIONS:
To be fiied in person or by mad with the CounlyAurlitor or Counry Recorder o! the oo�nry whe/e tl�e properry is located.
Fitirg Dates: 1 J Real Property: Must fi7e durirg Ne year (or which the deduction is sought. c
2) Afo6de / Manu/aUu2d Homes not assessed as Real Property: Must file dunng the twelve (72) mon1H� P
belae Maich 31 of each year the deduction is sought.
See reverse side (oraddrtional insfructions ApA.pu9lrfications. ��j/_
AAelsed ralue cf real P�D�Y � ot
Alart� 7, amm year
If m. what tr his I her e�raU share o'�
If nama m 2coN e dilferenl Nan U
�v f4^oe� i �gai
uWirem Delow.
Pdd�s of rtnrtga9� m m�baU sWer (nuribe` and sbeeG uA: state.
Name of asvgnee or oNr owner w haldu af �miga9e
PdOress of assignee (nvmber aM atree4 �Y. ste:e, aM LP cade)
pces g�tant wm poperty in any other If yes, what a
counry n Ind"ana? �] Yes ❑ No
1 �,CoumyAUditw
County Recorder
GIBSON COUNTY q
.��o -v w wa-v� r � �
unPaiE az U Morl9age / Cmvar� uWebtedness �m ' az of Is Me aPPfimnl tlx sok
Eata of aDP�� � a epuita6le awreY.�
� ❑ Yes ❑ No
tt pwned with someone other ihan spause, u�dicate wNh whom
Is the pmperty in Ouestion: Mnua9y Asussed
� Reel PfoPerq' ❑ H!?wallyAssessed . . .
code)
Nc dedumon been reGU�ted m p�ape+ty
�� ❑ Yes ❑ No