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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS vear
ry= FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-09)
`` aresaitee q oeparhriem ot Lod Govemmem Fu�arre
I� f�(
wsraucnoNS� JAN
To be fiied in person w by mail witlr the CountyAuditor or Counry Recorder of the counry where the property is located. ��� ��
Filing Dates: 7J Real Property: Must flle during the }rearfir which Ihe deducfion is soughL C.�. unry Audrtor
2) Mobile / Manu/adured Homes rat assesced as Real Pmperty Must hle during the fwelve (12J monNs
before MarcA 31 0/ each year the deduction is sought. unly Recorder
GIBSON C0. R
See reverse side (or addftronal instructrons and qualifications. �
I//"lowreror�_/ �W T �6.(/Y/de� . ��-/�-e/1J
T ng Distriri Key rumCW/ legal desaip �
�i . a6 - - �- /o/- o0
AacssM rWUe dreal popertY as d �1�r[q�p e/ Cantra� irdehtetlness unPak
Mamh 1. tlnrnt Y� Alarrh i. airrent yPAr
��.,�,����,�.���,�� O O
It narne m recad'a Q1ffe2nl Wn thaf of aDG�. uWicate Eelmr.
rlame ot rtattpagee «ca,vaa se0e� , n n
Mdres of rtnrtgagee or contraG se0er (numbe� and stree; cdy, sfaie, aM LP ooCe)
or oticer owner w nolaer ot morigage
�',
Dces aPd�a � WoPP+�Y � any oNer
muNy m InEana? ❑ Ye5 ❑
aM
If yrs. what cmint�R
. ��-OJ-L o 598"
�s N Ma[qa9e / CaYSari cWebtedness �mC� m d Is iM ePW�t Me sole
date of ePP�� �gal a eWitada ownell
-- ❑ Yes ❑ No
°�"�' """' �°"'�" 1�,� 5, KO1i,t��77 w
✓l,�Dlj�! �
o?O!D �5-jr'�',_3
4,�e, � � 3 ? /
N/hal Tantg DisMd? Has Vus AeEUCCOn Deen reQuested at pmpeM1y
���� ❑ No
❑ Yes
COUNTYAUDROR
DrducOOn aGW�+� 6� Ne amount af:
20 _ 20 _ 20 20 _ 20 _ 20 _ 20 _
SigraMe d Cmmb Auditor Counry Date (nnruh, daY. Y�A
C-
I/ We ceruty undu the penalry of 'ury that the ve arM foregoing infortnalion is W e and cortect aM fhat Me applirant is a resident of Indiana and
owner I contracl buyer ot the aforeme�oned p rty on date application is filed.
SlgreLUe (o� e) Date (monN, Oey, yea�
�=ull2siCent addras ol app(cant (numbe�antl sbee4 �: state, ard LP aotle)
D z L t�i K 7 Y�
Psmn auNa¢eO EY Auy exewced Power ofAnomey or by IC 6t.i-t2-0.7 Date (month, tlaY. Y��)
PdCress d authd¢EO perm� (number arM SLeef, ci/y, sfale. and ZfP code) .