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.�"'* ' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R8 / 2-0� �
�' 1 Resrnbed by Depanme�t of Local Govemmenl Finance
Ni�
wsrnucnoNS: AP R'��^'��'009
To be filed in person or by mad with the CountyAuditor o/ the courtty where the property is bcated.
Fding Dates: 1) Real Property.' Dunng the 12 months befae June 11 d the year tha deducbon is to be e/(ective. �y� /1�
2) Mo6ile Homes assessed �mder IC 6-1.1-7: Behwen January 15 and Ma/ch 2 0l the yeer the deductim is to tf4 A 4' '
See reverse side (or addiGonal instructions ard qualifications. � �
GIBSON COUNTY AUDITOR
aypicarrt(ownerdmn(raCbyyer- e�verse
/� O O/ A(� T
Disttid
��
ofiNe�est?
If reme on record is diHereM ihan thffi of
��qp�� Reoord number Page number
- �a -.�oo -ooa_��o - o�-y o a—
Malgase � co�trati ind ness unc� as or Marrh 1. �s u,e appGont u�a sde �e9al a«r,ii�aae w.nen
wrrent yoar �f l
p� � ���v ❑Yes ❑No
If owned wGh sort�eme WMr t7w� spouse, irWifate wiih whom.
Is U�e property in queslian:
❑ R�I Pmperty ❑ Modle Hane QC 6-1.
Name of nartgagee orconUacl seller ��
Addrass of moM�e m m�vaA seller (ixunbra arM sLeeG ml: s6te. and LP caCe)
w Nlier owr�ar w hdder o( martga9e
of assignee (muMer aM sVee1 rnl:
Does applicant own property in erry aner
courrty in Indana?
❑ Yes ❑ No
om„�ao� ��,ed � u,a �a,oi or:
�4�7
Signature of CaunryAUtlilor
20 _
a
If yes, whal countyt
�_
Has tho dadudian bean re9ursted on piaperty
rw a,rtenl yesR '
❑Yes ❑No
COUNTYAUDROR -- _
6'r�qu /-1lJc.�� -----_
�°— T �Bo2A /-� -
��
I/ We certify und�ifhe penalry af pe� ihat ihe above and fwegoing infwmation is W
Indiana and owner of fhe aforemen ed property on March 1, 20
� Signanue(owne/slWlname) .
�.�' s of appl' �anbei antl s6eef. aty. sfate. and ZfP mde)
MPersun aulha¢ed by duy erzeMed Power d A�U,anJey w Dy I 61.1-12- 7 ����
FS`( S S� �s� W�
AdNess of aulhor¢ed person (number arW straet. cEy. sfefe, arM LP mde)
� _ // /� ]f
Date (month, aay, ro..., —
Dale (monN. daY. Y��)