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.�+°•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
r�: ., _? FOR DEDUCTION FROM ASSESSED VALUATION � ��
� State fam 43709 (RS / 2-07)
S w» � Presmbed by Oepartment ot Local Govemment Firiar�ce
iNSraucnoNS: JUN�el '! 2008
To be filed in person or by mad wdh the CountyAuditor o/ the county wheie the pioperly is located.
Fd'o,g Dates: 1) Real RopeRy: During the 72 months be%re June 17 d Ure yea� the deduc6on is fo be eReclive.
2J Mo6ile Homes assessed under IC fr 7.7-7: Behwen January 15 and Mardr 2 0/ the year fAe deduction is to b�.,Q�
See /everse side for additional instructions and qualfications.
GIBSON COUNTY AUDITOR
Apqican owneforcontr{dqyr ei- ere}Yncfi anieversesitle) / n
1/ A/f i. y� f .. n n �L /( .t � i��(! �
-OG /'-/0/-Goa.7�� U/7 " U
�e ot real as af Marth i, arrenl ymr Matgage I ConhaG indabtedrress unpaid az of March 1, Is �he appliont Ihe sde legal a
nirrentyear ^^� �
�.n_tii
his I her ezacl share af interest? I( awned wi�h sort�eone ather lhan spause. indica�e with wiwm.
If �me on record is diRerent �han
Name of mortgagee orcanlraG
mnlraC seller
or other owner rn holder ot mortga9e
Address ol assignee (nwnbe� and shee(
Dces applicanl own property in arry other
oounry in Indiana?
❑Yes � No
tity, �5(ate, ard
If yes, what counryl
�Is propertyinquwtion:
eal Pmperty ❑ Mobile Home
� ,' .
. � �a7,,
D1"���'CI' ��.�...
COUNTYAUDROF �, •
��
❑ No
o�m
)No
Deduction apprwed in the amount oC � � �^ 3 ' � �
CaC(i \� . ..:......:..... .....
p � 20 _ 20 Zb _ �N �✓ °� 3a� � �% C
SigraWre of CounryAuditar Caunry Date (rtmth. day, yea�
I/ We certify under [he penalty of pe�ury ihat the abwe and foregoing infortnation is true and correc[ and Uwt the applicanis was / were a resident of
Indiana and owner of the afwementioned property on March 1, 20 _
of applicanf (number and shaef. cify. stafe,
Person autMr¢ed by duy exewted
a
Address of aulhwaed persai (num6er arM sUee4 dly. sfate, arM ZIP mde)
Date (month, daY. Y��)
(mmth. daY Y��