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. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C n - Tav hi ear
_ FOR DEDUCTION FROM ASSESSED VALUATION
9a1e Form 43709 (R10 /11-08)
` � Prewibed hY �PaMrent d lod GovemmaM F�arce
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lNSTRUCTIONS: Ile a
To be file0 in persm a 6y med witli the CountyAuditor d the county where Ne property is fxateC.
Filirg Dafes: 7J Real P�operty: Must /de during fhe year /or which fhe dedudion is saught. ,(�
2) Mob�7e /Manulacluretl Homes not assessed as Real Property: Must RIe durirg �e tweAre (12J mmihs be�A a�'31 o year
the tleduttion is �ht. '�
GIBSON COUMTY AUDITOR
See reverse sde /d add4ional insWCfions anr/ qualifm.ations .
FWV���N (oM*Yf.n mNiaci MNa- �56iCians m�ewpeside) i
' �� �_
value d real popeM aa d Martgage / Cartlrad o
Mamf� 1. ameN yaa Maich 1. cwreN year
If ro. whaf o hb / her exatl shae d irtle`es17
u nxme on remd'a S�erem uan u�al m aw�L o,eimm cab.-
rtioriBaBee v
Name d assfBrree w oNer ovmer a taldm d rtmrt9a9a
Pddress N asipnea (m�m6tr and sbeet. �Y. s6fc. and 21P aEO)
Does a00��1 own VopenY in mry othar tl yes. what
munN in IMmro7 r—� .. �--� _ .
� V �Y� � d •
ess unpeid as d Morlpapa / Conh
dale o( app6mEo
I( amed with sameone a1h
� /`
' � �/ .
COUNTY
Oistritl7
as N Is lha aV7�M Ihe sole
legal a ep�r.taWe wneR
� ❑ Yes ❑ No
Is iha PWaM in Guestion: MnuaOy Assessad
�RealPmperty ❑MnuallyASSes.sed
AAohile F1ort�e QC 6
Has �his dedud'an been �eauested on rnoGaM
br wrrerM1 Yea(! �--� _ . �--� .
Mud'an a0vmved in Na amou�n of:
lll-:1�1'�I" i��. �0.. �]
20� 20_ 20_ 20_ O•�•..... 20
3nafu�BdCOU^tyAuditar l...Z���y j��O. .../.���.
)../ ...... �
I I We certify unda the penalty of perjury that ihe above arW foregdng mfor�......_..._ _ �t af InOiana and
owner I mntract bu r of fhe aforementioned property on tlate application is filed.
7natura�(°w'!YS PF) / Oate (rtwnlh, eaY.Y��
by Euly elwifaE Pawar d
persm (nvn6orantlsLeef,tlty,sbto.
1-12-0.7
Da�e (rt�orrth. EaY• Y��)
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