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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. w� / State Form a3709 (RS / 4-03) �
� P2sGribed by Departmeni of Laal Govemment Firiarice ��
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wsrRUCnoNS: MAR 2 ZOO] File Mark
To be filed in person or by mail with the County Auditor of the county where the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 0) the year the deduction islo be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o(�t�re qeqr,(tie�� uction is to be eHective.
See reverse side for additronal instructions and quali�cations. GIBSON COUNTY AUBiTOa
�P�
1(owner or contract
,Gl�J �--
Dislrid
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Assessed value ot real property as of
March 1, current year
res(nctions on reverse
It no, whaf is his / her exact share of interest?
If name on record is different lhan that of
mortgagee or contract seller
Key numb r/ le al descrfpjion Record number
�6-19-�s �i -�oa. � I 6-Cx�S
�C � Q�a � � _ � Page number
Mortgage / Contract indebtedness unpaid as of Is ihe applii
March 1, current year owne(?
9�. D o �
indicate below:
.
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1 the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address o( mortgagee or conVad seller (number and sf�et, city, state, ZIP
Name�
-"'- ^� hniAer of mortgage
Is the property in question:
❑ Real Property ❑ Modle Hane (IC 61.
Addre: DC3�5'et' 1�iQ, °�-CJ�J �p . � � �de)
Does CarCl \���%�y ,�-N�. n � �
�, , rj �S' • What Taxing District. H os ert15 fordcurrentb ear? Q Yese❑ No
count ......... ! P P Y Y
COUNTY AUDITOR
Deduclion approved in the amount of:
20
Signature
zo�j_ zo o`+ zo I 20
P P
Couniy Auditor
zo
Date
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certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
full name)
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
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