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.•�•n STATEMENT OF MORTGAGE OR.CONTRACT INDEBTEDNESS n 7 s'p . Year
r;, .,, FOR DEDUCTION FROM ASSESSED VALUATION �-
.� 1 SUIe Form a3709 (R8/ 2-07) M R 2 7 2009
Presaibed Dy Deparlment of Local Govemment Firiance
INSTRUCTIONS: �-yH File Ma�c
Q �l6�., �cs iJs-g
To 6e filed in person or by mail wdh Me CountyAuditor o(the county where lhe property is located. � Q �/
Fding Dates: 1J Real Property: Dunng the 72 months be/we June 11 o/the yearthe deduction is to be elfec6ve. GIBSON COUNTY AUDITOR
2J Mobile Homes assessed under IC 6-1.1-7: Behveen Januery 75 and March 2 0/ the year the deduction is to ba e//ective.
See reverse side fa additional insWclions and qualifications.
w conVad 6�yer - resfncYims m reverse sitle)
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Key number I legal desaipG
� aG / - 3�-,200-
f 2al property as of Maich 1. amenl year Mortgage / ConV
Whdl IS h15 I FC! QFdCI Sh2f8 Oi If1ICl85l�
recad is different Nan that of applicant, indifate below:
Name of mortgagee or contract seller
w mntrad seller (number arM sheet. tiry, sfate, end ZIP code)
of assignce or alher axrrer rn holder of mMgage
ot asvgnee (n�un6el eM sfreel. ctity. sfate. entl ZIP wde)
Does appliwnt a.m praperty in arry other If yes,
counry in Indiana? .
❑Yes ❑ No
Deduclion appmvad in the amount ot
��
I I we cerafy
Indiana and �
�
fr the penalry of
.r oi the aforeme
name) 11
3i7 -
iess unpaid as
If ow�ned with sortieone dher ihan spouse. indicate wiU whom.
U
or eq�nuae wmer
❑Yes ❑ No
Is Ihe propeM1y in queslion:
❑ Real Prooertv ❑ Mobile Home
ctim been requested on qoperty
_"'_ '_ �
COUNTYAUDITOR D? a��'CI' ��'Q p�%f�. . //��
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C8Y(� 1�r0. . —
20 _ 20 _ � .................... —
"u°.�� •�✓� ��7 �y� 0�—
Cwny I Date (mu.,,., �� Gw
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hat the above and foregoing infortnation is true and cortect and that the applinnts was / were e resident of
ProP�Y on March 1. 20
� Date (monN, tley, yee�
anC sGeef. cify.�jfa�.' and ZIP code)
Adtlress of author¢etl parson (number aM s4eef. cily. state. and ZIP code)
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