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^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
:,_-..
� FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 63709 (R71 / 6-09)
�' � PresrtiGeE by DepartmeM o( LnW Gm�emment Ftriance
Year
INSTRUCTIONS: � ' '
To be filed in person a by mail with the CountyAuditor or Counry Recorder o! the county where the pioperty is located. �
Filirg Dates: 7/ Real Property: Musf file dunrg Me year lor which tha detluclion is sought.
2) Mo6de /Manufactured Hortres not assessed as Real PropeRy Must fi7e dunng the iweHe (12J monfhs J N�-5 � Auditw
6efoie March 37 0( each year the deduction is sought Q Counry Recorder
See reverse side for addifional instrucUons and qualificaLOns. �.
ownerarcontraU vyer- mreverse '
� GIBSON COUNTY AUDITOR
Ta�vng DistrBY � _ Key rwm6er / le9al 'Ption � . Recad number Page num0er
�11-�•�vvnn.
ns�e �we �r � a�«iy � a
Marh 1, aa'eni yrar
rq, what is ha ! Mr e�ct share ot interesY?
II name m recoN is dittarnt Nan that of apFGCan� iMicate Eebw
Name of maV3a9ee v mnbact 5e4er
SP���E�F G�AN�+csw�
PDdress of rtungagee or contract seller (number and streef, ctiy, sfate,
Name of assignee or other owner or halder of mmgage
AAtlress of assynee (number aM sfree4 mY. �te, antl Z/P cotle)
unpaid as of Is Me apd�+� n+e sole
legal w epuflahle ovmeR
n Yes ❑ No
someorie aner inan spouse.
Is Ihe WbD�Y in 9uestion: MnuaMl�sessed
i] Real Roperty ❑ MnuallyAssessed
Mobile Fbme (IC 61.1
(Ooes applicant ovm propeety in any olher I If yes. what counry? I What Tauig DisMr1? I Has Na detlurlbn been repuested m property I
m,euy m �naaua ❑ ves ❑ No ro. a,rma real+ ❑ ves ❑ No