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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
, FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 93709 (R71 / 6-09)
` PresaiEetl M Departmerrt alloml GovemmeM Fmarre
INSTRUCTIONS:
To be filed in person w by mail with the CounryAudkor or Counry Recorder o( fhe munry whem [he p�operty a located.
FiNrg Dates: 1) Real Pmparty: Must ble durirg Vre }rear fw which the deducfion is saght.
2) Mobde / Manulactu2d Homes rrot assessed as Real Pruperty Mus[ file dunng the hvelve (12) months
6efae March 31 o/exA year the deduUion is swght.
See reverse side for addAional inshuctions and qualficatoons.
p�operty as ol
rc �o. wha� Is ttis � 1cer ama share of in�a
tt(wne m'emtl is dAterent lhan ihai W appOqnt, in
Name af �ee or mntract se9er
i
pddress W rtprtgagee or contrap se�er (number and
ME2ss oi assignea (numbe� and sdret �: s7a1e. antl
Dces e�imnt ovm pmperry in eny oNer
munry m Ind'ana? I�'1 .,_ _ rl .�_
�— � �—
r v�-w .
1 Contraa'vdebtednPSS unpaid as U Mortgage / C
wrtem yrar tlate of appGc
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❑ Caunry Remnder
GIBSON COUNTY AUDIT01
R¢conE numbc Page �wmEa
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tlehtedness �mG� a d La Me ePP�� tha sob
Iegal or equitade owneYl
�� ❑ Yes ❑ No
3n eP�Te. ifdirate with ximni
Is p�operty in Guestlm: MnuaOy Assesse0
Real ProPeKY ❑ ?�!?��!�Y �
state. aM LP cade)
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�/ - � -/� Ac
iat mun1�7 Wl�at 7arifg D'ctrict?
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I/ We cert'rfy uMer Ne penalry of perjury Nat the above arW faregoing infortnalion is true
owner I mntrad buver of Ne aforementioned property on date appllcation is filed.
appr c(numner am srieeG �r. srare. ard Lr mee)
�"oo � �F<nr a�+.,.�t� e,�t �7� �8'
q, awr �ea,�a aa.,�s orauor„ey or M ic ei.�-�z-0.�
xd pe�son (numGer and sbeet �l% sbte. eM LP oode) .
requested m P�O�Y
❑ Yes_�_No_
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��y,� �
a�o,��7�
, _...., a �esaent ot IrWiana ard
Date (monfi. daY. Y��
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