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"'na STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
__ . FOR DEDUCTION FROM ASSESSED VALUATION
, State Fortn 43709 (R71 / 6-09)
4' ,.,. f Presrnbetl by DePartment of Local Govemment Frence
INSTRUCTIONS:
To 6e filed in person or by mail with the CountyAUdifor or Counry Reco�der o( the county where [he property is lorated.
Filing Dates: i) Real Property: Must file dunng fhe year /or which the deduction is sought.
2) Mo6de / Manufactured Homes not assessed as Real Property: Must file dunrg the fweNe (72) months
6efore Ma�ch 31 oteach yearNe deduction is sought.
See 2verse side for additional instiuctions and oual�cafions.
Asxss2d value d real praperty as o(
' 7. anen� year
I( �a. what is his! her eraU share of interest?
It name m mcwtl is tliRerent than Nat ol appl
Name of rroyagee or contraG seller /
��
Address of rmrtgagee or contract seller (num
Name of assignee w oNer awner or h e$
Oces apdimnt wm pmperty in any i
counry in Intliara?
❑ Yes
� — —/ � �
Mortgage / ConbacS irMehtedness unpaid as of Mongage / Cc
March 7, wrrent year �ate of applic
If owned wiM someone
slafe,
No
�
� �� _
PP711:YiLL114YCi7:7
Deductirn appraved in Ihe amount of:
� � � 2a_
SigriaWre W CamryAUditor (
1/ We fy undeqffie�enalry of perjury that Ne above and foregoing intom�at
own / ntract b�yer q`F the aforerpprttioned pro0erty on�date applicatlon is file
A� J[.auray.RUditor
C � Recorder
GIBSON COUNTY AUDITOR
Recortf numDer Page nu
�npaid as of Is Ihe eppl4snt Ih sde
�/y� kgal w epurtzde oxneR
1 P J ❑ Yes ❑ No
,,i--s.-,m,//e v�uem �n a�escron: r�o�eM assessee
�Real Property ❑ Armualry Assessed
Mobile Home fIC Gt.
Na5 ihis EeAUtlion Deen 2QueSleE at P�DP+IY
tor ammt Y�� r-i .. r-i .
AN�E�.a� m sPr� �
I I � ��G`�
. ,.br.raad
Person auUrof¢etl by dWy executeE Power af Attwney w by IC 61.1-12-0.7 . I Da�e (nronN. tl2y,
AEdress of aWroraed person (numberarM sbee4 �ry, sb(e, antl LP cade) _
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