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�^•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION I•
'� �� State Fam d3709 (R71 / 6-09) ' 1 lJ�7ll � r1Y'� �� �
�`� � PreunbeC Dy Departmeni ot Local Govemment Finance ��
File Mark
INSTRUCTIONS:
To be filed in person or by mail. o fil vnth:
Filing Dates: 7) Real Property.' Must be completed and dated in the calendar year for which the deduction is soughf.
Must be �led with Ne County Auditor or County Recorder o/ the wunty where the property is located
on or before January 5 of the immetliately suoceeding calendar year. Coun Remrder
2) Mobile / Manulactured Homes not assessed as Real Property: Must file with the County Auditor of the
oounty where the property is located dunng the tweNe (12) months be%re March 31 oI each year Ihe
deduclion is sought. '
See raverse side (or additional instruclions and qualifications.
App6cant (owner w conhaa buye�- sae msfictions on reverse sitle)
T' �� i/��_ _ i �, i/•�_
Assesse0 vahie d real pfopenY as
MatCi t artem year
� o?3g.�lEO.�
If tw, wha� is his / her exap share
curtent year
i5cn.CCO ��
II name on recoid is Eitferent Nan Nat of appfrcen; intlicate Eebw:
Na�me )ot Lmortgagee or mntraa uuer m
i�r1 � �"'SOC{'GYtOL Wf��Ci�I�Y\
PdCress of mon9agee or con q� r(eL�i a1n,tl�street ciry. stafe, aM` ZIP code)
"� �ort'oCtc�- (.�L�1 ` ti. L4l.�.C'Q\ 1.�
Name ol assignee o�r e�t� r� t mwtgage
AdEress of assiqnee (numDer and shaet, tiy, sfate, aM Z/P code)
as
C .'J.
GIBSON COUNTY
•� b rd number Page numDer
S
btedness unpaid as o Is the appGrant Ne
legal w equitade ameY?
`A Yes ❑ No
SPOlISE. If1EN'218 W1�II Wlqfll
15 N8 P�PQrtY in Questbn: MnuaOy AssesseE
� Real PropertY ❑ MnuaOy Pssessed
Modle Home (IC 6
Dces aDVGqnt wm property in any other If yes, what counry? What Taxing Disvict? Has Nis Eeduction been requestetl on pmperty I
county in IMiana7 rf� fa wrtent yea(1 r�1
n Yes lbl No Lb1 Yes ❑ No
y