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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T p Year
_rt FOR DEDUCTION FROM ASSESSED VALUATION
� State Form d3709 (R70 /fl-08j .
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To be frled in person or 6y mad with Ure CountyAuditor d the county wFrere the property is loceted.
Filirg Dales: i) Real PropeAy Must Re duing fhe yenr /or whirh Ihe deduction is sought. �
2) Mobde /MamdacWred Homes not assessed es Real P�oparty: Mus! fde duniy the hveNe (f 2) mmths 6elde���ach year
thedeCuctionissauyht. ^ GIBSON COUNTY AUDITOR
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❑ Yes ❑ No
M rw. whal is hk I hm ezad share d iMeresYt ' tl ownad with someone other Uw� spouse, udicale wilh Wom
tl(ume m(emd is d'�«em Wn Iha1 of apD�1, iMimfe beWr. Is Ihe V��nY in auestian: Amuaq AssessaE
❑ Real Propany ❑ iw,uaty nssessm
/ I Mohile Hane (IC 6-1.1
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aaares: d �orl�agea or ramraa sea
Name d asigrree ar other o�wner a h � �
Pddress d asipnee (nurtborand sLec .�p� \J' � � �
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DeEUdian aODroved in tl�a amour� of:
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aetluamn DBen �aaueslea on G�M
m �� ❑ Yes
❑ No
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M�l�q mYAUdila /I ��������� O��IY�� -- �el�(DyOd
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I/ We certify uMer th nalty of pe� _.._ ...�..yoing ui(ortnation is We antl cwred and that the applirant is a resideN of
owner I mnVad buyer of the aforemc�motrt,W (xopeRy on date applkafion is filed. �
�natura ( ) Data ( yr.ar)
� �� ,�/��� � 6 � �a;�
U residem adErass d a t(� aW sbeel, city. abfe. and ZIP aodc1 _
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aulhaaed by duly e+ewted Pawer o( Albmey v Ey
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parsm (n(rnOri and at�eat, ary, saro, ana tir caooJ � � /
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