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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Count Townshi Year
FOR DEDUCTION FROM ASSESSED VALUATION P
��j + State Fortn 43709 (R6 / SO6) � a�
� Presai6ed by Depertmenl of Local Govemment Finance 1
1
�NSrRUCnoNS: JUN 1 1 2007F�ie ^^a�
To be filed in person or by mail with the County Audito� of the county where the p�operty is located. .
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune 11 0/ the year lhe deduciion is7A?ke efie�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of ��ie y�t e�ction is to be etfective.
GIBSON COUNTY AUDITOR
See reverse side for additional instnictions and quali�cations.
(owner or
Taxing Dislrict
�./.la
6uyer- see resMctions on reverse side)
U Key number / legaj/description Record number
/
�.�� a �-��-� � -�oi-aao, 3� -o a�number
Assessed value of real properiy as of
March 1, wrrent year
what is his / her exact share of interest?
MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year - owneR �les ❑ No
/
If owned with someone other than spouse, indicate with whom.
name on record is dif(erent than ihat of applicanl, indicate below:
�me of mortgagee or contred seller /� ,
( i .f/zi. // i
idress of mortgagee ar conUact seller (number and st2et, c, state, ZI,
❑ Mabile Home (IC 61.1
Name of assignee or othei owner or holder of mortgage V,�; __ ��
_.,,c�-0 �_ n�
_,�2
Address of assignee (number and st2ef, city, state, ZIP code) ���a }5'C�• l�rO (�/�
Dces applicant own property in any other If yes, what county? N. C�1'�� 11rO �� J� requested on
county in indiana? � ?[] Yes� No
��'��� �•...
COUNTY AUDITOR
�
Signature
approved in the amount
20 ��
20 � 20 20
�
County Auditar
20
20
We certity under the penalry of perjury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
7 5 ('F S�-
;�t address of applicant
Person authorized by duly executed Power of Attomey
Owe�.-s v: f�c .To�! Y7�c o� by ic s-�.�-iz-.o�
person