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"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_, • FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (Rt t/ 6O9)
S Presaioed by oev��� � �aw covemment Fnarice
"" File Mark
wsrnucnoNs
To be lled in person or by mail with fhe CounlyAuditor or Counry Recorder o( the wunty whe2 the property is located.
Fdirg Dates: 1) Real PropeRy: Must �le during the year for which the deduction is sough[. AuEimr
2) Mo6Ae / Manufactured Homes rrot assessed as Real Properfy: Musf h7e dunng the M1velve (72) months C
6efore March 37 of each year the deduction is sayht Co er
See reverse side (w addifional instructions and qualificationi. GI BSON COUNTY AU
i. _ . ... __ __ �_.,..__� '___�._._.,._.....,...,.... �.
MarU 7. aareN yrar
�i M. W�Id� 6 �CS � hEf Ell2fl
It nartie on rern�d s tliRe�a
A[ey numbefl legal desaiptirn /
1/ _ s a -
250f MOr�qBye/COntraG�._3GG
Alarrh 1, curtent ypar
3R Oi 1(ISCRSl/
an Ihat W apP��t'oidirate Eebw.
rame of nwrtg29� a�anvact sellu
AddRss ot mat9a9� or cantrad sr�er
Nama ot assignee or oche� rnmer or hd
AGCmss of assignea (number ard atree
unpaid as ot Mwigage I Contrart i'Mebtedness unpaid es o( Is Ne appivant me sae
date of appfitatian �egal w equitade owneYl
�U O � ❑ Yes ❑ No
If ownetl wtth samea�re oth�r ihan sPW�. iMimte wttA M1mm
Is property in QuesUm: MmiaOy ASSessed
Rfa1PfOPeRY ❑!!M!�h1.�...
stafe, aAd ZIP aode)
t'dy. slafi. aM Z/P t04e)
les a plionl oxn P�P�Y in anY oNU If yes. whal
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{�Zu�, m�'t oo� c.
D�— 5.3(0l
couNTrnuortoa
Oislrict? I Has Nis dedutlion been requested on propelly
for turtent ynaY! ❑ Yes ❑ No
_ Zo_ p_ �_ zo_
Couny Date (rtrontli. OaY. Ye?�1
I/ We certify u�er Ne penalry ot perjury Uat Ihe above and foregoing intwmation is We and cortec[ and that Ne appli�ant is a resident of I�iana aiW
owner I conVaG buyer of the aforementioned property on date apDlication is fiied.
�.._.._.._.... r.n..,..,e� \. � Date (monfi. daY, yea�
of
�f ap�l'cant (numbb�andslreet tlry, slate, i m
� l,t� � h S ��'
EWy executed Pov.er of nttaney or Dy IC 6L1d 2-07
I persan (number arid sbeef. dty, sfare, and LP code)
Oate (monfi,