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""+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u To sh Year
___ . FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (Rti / 6�O�J)
,' ,,,, ` Presaibed M Departmenl of Local Govemmerit Firianre �
wsraucnoNS:
MAY �Ve�pUIU
To 6e fi/ed in person or by mail wifh the CountyAUditor o� Counry RecoNe� o/ the counry where fhe propeRy is located. F� �� ��
Fitirg Dates: 7) Real Property: Must fde dunng the year (or which the deductlon is sought. ty Auditnr
2) Mo6ile / Manufactured Homes rat assessed as Real Pmperty: Must file dunng the twelve (72) monMs ❑tv ��r�
before Ma�ch 37 o/each year the deduction is sougAf. GIBSON O Y�Dfi OF e�
Sae 2verse side fo� adddtiona/ inshuctions and qualifications. _
Tarin9 �' / Key number / leg[/1 �p O l%— W"C..CI �. T 0 �/—V �
J
vahre d real as o( Mor�qage / ContraG intle6tedn¢s unpaid as d Mongage / Cantract irME
Mamh 1, wrent year Mart�h 1, wrtent�^ O O O� Cate of appticatim
J
It rw. what fs his / her e�tl shara of inleresi? If ovmad with someo�re other ihan
on 2coN is d�ferent fhan
mortgagee or mnVacl seller
contract seAer (number and street �Ty, 5a�, aM
Nama of assignee or aiher mmer or holder of fmrtgage
AOdresSOtasvgnee(numb[ �"'—'-�'�onvlel. _"
__—
Dces applinm own P�7e� � 1 ij l l' (,' ]� i CX O 1 O �.�dr
counrymind2na? r 1\Q.
` ..................
Cat'(� �70....P,��� 9R
Deduction aowoveE in ihe: • • • • • • • • . . . . . .
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I I We certify un
owner I contract
—� �O� Du�. �c�
Eent atldress W appfi�ani (n
P�3� �tl- �i
autl�a¢etl by duty rsewted
�
unpaiC as of Is ihe epp(irant
legal or equitabl
❑ Yes
Is Me property in qunstion: MnuaDy Asessed
❑ Rea� Roaenv ❑ amua�y wssessea
Moble Fiome fIC 6
Has Nis dedurdon Eeen requested m property
tor curtent YeeR r-i __ r-� .
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I�nn �qLC1 �— I oate lmonm, a�r� _ V
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above and foregoing information is We and cortect arM that the applirant is a resident of Indiana ami
�erty on date application is filed.
Date (rtrnlh. daY. YgaA
' - -.. 5-- — h — /!�
fily, sfate, aMZIP
person (numGer antl sncet tdy, state. aM Z!P code)
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