Mortgage_Vickers°'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
FOR DEDUCTION FROM ASSESSED VALUATION � ��
Slate Form 43709 (RB I 2-07)
�' � Presrnbed by Departmenl of Local Govemment Finance
File Mark
rNSrnucnoNS: JUN 6 Z008
To be hled in person or 6y mad wdh fhe CouMyAuditor oI the county where the property is bcated.
Fding Dates: 1 J Real Property: Dunng the 12 months befare June 1i d the }rear lfre deduction is to be eRecGve.
2) Mobile Homes assessed under IC 67J-7: Behveen January 15 and March 2 0( the year fhe deduc6ar is to ��
See raverse side /w additional insWCtions and quali�cations.
GIBSON COUNTY AUDITOR
Apqicar�{ (owner w mn6ad buyer - see resLictims m iever�4 side);
Tadrg
�
1. aarent y�t
his / her pacact share of interest?
If reme m recwC is different Ihan
desaiplbn
Name of rtwrtga9� o.�Ua� sel�e� /�/�
J
Adtlress of mortgagee ar mnlracl seller (numberantl sheet, dty, stafe.
Name ot assignee or olher o+rne` or holder of mortga9e
Address of assgnee (mmibu and streel, tity. state, and ZlP rode)
oces aca�m o�m a�rtv �n ery aner
caunty in Indaria7
❑Yes ❑ No
DeduUion approved in Ihe amaunl
2p �$__ I 20 � r1
SgnaWre of
��res,�a�
Pi�7
Conlrad indqEA�
�U .30
�
¢ss �mp�id as of March 1, Is
5a
�'
If wmed wiTh someone alher Ihan sF
8
Record number Page number
l /ii / 'll % � �i
w equitable wrtreR
❑Yes ❑ No
poperty in question:
el Prpperty ❑ Mobile Home (IC 61.
i.. 1 . . � .�
! Dra���cr NO .:.........:.......
' Card Np, �57g'3Y
'r .......... .O. ..
1 � $q3o9.5 �o���
1 IJYes ❑ No
20 _ I 20
Dale (mmth. daY.Y�A
20
I! We certify under Ne penally of perjury ihat the above and foregoing information is We and correct and that the applicanfs was I were a resident of
Indiana and owner oT the afwementioned propeAy on March 1. 20 �
...�....e r.,,.,..e�� Rn.�,.�� . Date (rtnnN, daY. Y��
�asident address of applicarri (num6er and sLeef, city. slate. and ZIP mde)
x Z�sco, E. (�Qae,\o� Qc� �1c.�.in�c1� , �
Permn a Wwr¢ed by duly azecvled Paver of Altaney a by IC 61.1-12-.07
AOOress of aullqr¢ed person (number arM sheel. aty, s(afe. aM ZIP ootle)
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