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.+°"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou � own i ear
�,, . FOR DEDUCTION FROM ASSESSED VALUATION
-�' State Fwm 43709 (R8 / 2-07) P R 0 1 2009
Presaibed by Depanment of local Govemment Finance
File Mark
INSTRUCT/ONS: ���'j/� � �
To be �led in person or by mai/ wRh fhe CountyAuditor o/the county where the property is located. - °�
Fding Dales: 1J Real Pmperty: Dunng the 12 months befae June 11 01 the year lhe deduction is to be eflec6ve. GIB1S�N C�,O�.NTY AUDITOR
2J Mobile Homes assessed under IC 61.1-7: Behveen January 15 end March 2 0( fhe year the deduction is o e ec ve.
See reverse side lw additional insWctions and quali(cations. �
�a isUict � Key number I legal desaiption
� a�-�� -�s-�� -�/. ��6 -c�
Pssessed value ot 2al po erty as of Mart�h 1, curenl year Morlgage I ConUaU iMeWedness unpaid as of March 1,
a,Rem rear .. . _ _ �
name on record is difierent ihan Ihal of applicant, iMitate below:
ame aee oT cmlraU seller
of m gagee a oonUaa seller (num6er aM sfreef, dty. 5afe, erW
assignee w Wier owner m
wm poperty in arry olhet
a?
❑ Yes ❑ No
Detluctbn appmved in the amount
20
20
Signature ot Caunry Autlibr
I/ We certi W r Ne
Indiana o r of tl
addiess
9afe, errdZlPaode)
It yes, whet counry7
20
Rew�d
someona dher than spouse, inScate with whom.
Whet 7adng .
COUNTY AUDITOR
20 20
Courrty
❑ No
Is pr rty in queslion:
❑ ❑ Mobile Hare (IC &1.
y���
� �.
�-�c �
�r 6 ,t1'
_ y� . No
/ � —
20
Dale (monN, Eay,
�
that the above and fwegoing infwmaGOn is W e and mrrect and that tlie appliwnts was I were a resident of
propeAy on March 7, 20
o� pn«�m, aey, year�
(number e� sVeet.
Power of Atlanay or by IC
Adtlress of aullur¢etl persan (numbeieM s6eef.
(monN, 0ey, yea�