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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C owns ip ar
� FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R10 /N-08)
� � PrasaibeE by DeGa�Nienl d Loral GovemmeM Finanm -
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To be filetl in person or 6y mad with fhe Couirty quditor d the oounty where fhe poperty is fxafed.
F7irrg Dates: iJ Real Property: Must Ble dwing the year for which the deduclion is sought. �-,�w�/ /!�da�r
2) Mo6ile / Manulactured Homes not assessed as Real P/operty: Must File tlurirg the hveNe (12) manths beloH M�c%�i. �t eacn yeer
the deduction is sought. c/ V
GI9SON COUNTY AUDITOR
See /everse sde !or adddional insWdions end qtralificaG"ms
App�nl(mmalmm�tractb(�ror�maios6ieionsgnmvnseside) .
n�r � :n� m �mares»
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Macame� eaness urmaia ss
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Name d mwtgagee �cantracl saDer � .
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MAress d moitpapee or contrad seAer (rtunber antl sbcet �sh:
Name N assiprrea or oiher oKner a halder d mMgape
MOress d aaignee (m�mbe� and sbed. d7% sbtn. and LP md
Does appGCant am poparty in arry alher H yes, .A
couMyinlnd'anaT � Yes ❑ Na
DeOuction appmved in tt�e amouM d:
0�9-0� � I ao�
dat8a0e / Ca�ad indehleMess unPaiO as d
u oNried witn someo�re
couNn nuorroa
20 � I 20 _ 2b _ I 20 _
Caunry
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SQIXI%,
Is Me D�vaM in Cue4ion: Amu
]Real Pmperty Q Mnua
Mohile
caiq Oie sde
ritable ovme(7
Yes ❑ No
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Mas this tleduCion bean �e7�esleO on O�PeM
mra,rremyean ,—,__ _.
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Dra��•c►• NO.. °�.......
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Card NO. . ����P..........
1! We certi(y under the penalty of per}iry ihat Ne above and foregoirg mfarmation is true an0 cwred and that Ihe applicant is a resdent af Indiana and
owner I mntrad buyer of Me aforementioned poperty on Eate ap0��� is filed.
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