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.+, "—"r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS nt T hi Year
ri .. E FOR DEDUCTION FROM ASSESSED VALUATION
S�ate Fwm 43709 (RB! 2d7) MA 1 2 2009
''; •� Prescribed by Department o1 Local Govemmenl Finance
INSTRUCTIONS: �� ����
To 6e filed in person or by mail wdh the County Auditor o/ the county where !he property is located. � Cl
Filing Dafes: 1) Real Property: Dunng the 72 months be/ae June 17 0( the year the deduction is to be ef(ecdve. GIBSON COUNTY AUDITOR
2) Mobile Homes assessed under IC 6-7.7-7: Belween January 75 and Ma2h 2 o/the year the deduc6on is fo be eAective.
See reverse side 7w addifional inshucLOns and qualifications.
see
inrg DisUia ' Kay number I legal desaiption Remrd number Page number
�6 -/4-1,8 - 3 03-00.0.- 9�- _o a-� . a l
-sessed vdue of 2al poperty as of March 1, amenl y�r Mwtgage ! CorNaci indebtedness unpaid as of March 1, Is ihe apptinnt Ne sole legal w equitahie wme(1
curtent year
7 S OOV ❑Yes ❑ No
� xhal is his I her exad share of interest? If oanetl wNi someone dher lhan spouu, indicate wi�h whom.
rame on record is difterent U�an �hat ot applicant, indipte below: Is �he ptoperty in question:
❑ Real Property ❑ Mobile Home (IC 61.
ame of mortaaaee or conUact seller
-� F� u ..
Adtlress of moM1gagee w wnl+a seller (numbei aM sheef. dty, state. a�d ZIP code)
Name of assigriee a other ow�r or hdder of mortgage
operty in any ofher
❑ Yes � No
Ifyes.whatcaunry? �Whal
Draw " '°P�"''
er NO:.. .. -.. �°2,/ ❑ r,o
COUNTYAUDIy/l- .("•Gar �TQ.:. ' .
Deduclion appioved in �he amount of: ` � • • � • • • •••• • • • ••• •
J F•«i %.S �jG� o 0
zo � zo _ zo _ zo zo _ � �� � , o
of Caunry Audilor
Counry
. I o�a �mmu,. dar. rea�
I I We certi�nder lhe penalry of�rjury that the above and toregoing infwma�on is We and mrreU and that ihe applicants was I were a resident ot
Indiana an owner of the aforem tioned property on March 1, 20
naWre� �(o!w`qers lull nart{re�)� /J \ Doate ( fh. day. yeeA
1 -f1v/'�ftiL /� /✓/y'./LZv�'�� J��i.0i�i3
II revdent atltlress ol applicanl (num6er en0 street. city, state. and ZIP wde)
/0� S� c%'Il4�1 S�. ��.�� ���,.��. , Zn/v�cy�
rson auihorizetl by duty exeated Power ot Atlomey o� Dy IC 61.1-12-.07 Oate (monN, tlay, yea�
Address of aulhor¢ed persan (numberaM sVeet aty. slate, aM ZlP mde)