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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
:.,_—
FOR DEDUCTION FROM ASSESSED VALUATION� ��
Siate Fortn 43709IR71 / fr09)
�' ,,,, � Presaibetl by OepartmeM of Lod GwemrtreN Fwnce
File Mark
�sraucnoNS: JUL 2 2012
Fortn filed wRh:
To 6e lled in person w by mail with the CountyAuditor w Counry RecoNer of the counry where the property is located.
F7irg Dates: 1) Real Properry: Must file dunng fhe year for which the deduction is soughG C.`�. � � County Auditor
2) MobBe / Manufactured Homes rrot assessed as Real Property. Musf file dunng Me twe onths
6efore March 37 0/ eacA year the deduction is soughG Counry Recorder
Seereversesidelqr�dtld'analinstructionsandqualifications. _GIBSONCOUNTYAUDITOR
ed value d real P�P�Y �
7. m`eiV year
number/Iegal aiPtion
-3�
�9a9e / Coniraa'uWebtetl�ss unpaid as of
Mart�h 7. wmnt YS�1 .-. �. _ _
If m, what a his! her e�aa share of interest?
11 iwne m recoN
rtrorig2g¢e ar mntraG seller
W mntrad SeOM (Nm6er end
assiry�ee w o�a ormer n Imlda of mortga9e �
Maress ot assi9�ee (numDei aM artee4 �Y- " �
�� .
Oces applimnt own propet^'' _�4 i
munry �n Indanaj 1 y`U l�i
�- SLU,p�"` �,R�-`'`� `a�,
_ ��'3 _
2l
I/ We certify under Uie penalry of
owner I contract buyer ot the afon
by duy ezewtetl Pw�er of Attorney
��
zo _ � zo
the above a
pmPertY of�
ard
Address of aWwaed person (number nM shee4 �Y. �re, and LP code)
Whal Ta�drg D'atrid?
20
Is Ne appG�znt Ne sde
legal or epuilahle ow�ul.+
❑ Yes ❑ No
y ^r''
Is Ihe PmPenY in 9uestion: MnueOyl�ssessed
❑RealProPe�b ❑?�!�M�
Mas Nis deduGbn
fw wrtent yeaR
�
(montn.
m propelty
❑ No
zo_
in(ortnation is We and cortect arM that Me applipnt is a resident of Indiana ard
ion is filed.
IN �-i � Co � O
Date (month. daY.