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.+°"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709 (RB / 2-07)
�° �a�� 1 F'resrnbed by DePartment of Local GovemmeM Firance
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INSTRUCT70NS:
To be filed in person or by mad with the CountyAuditor oI the couMy whe/a the properfy is bcated.
Fding Dates: 1) Real Properfy Dunng the 12 months before June 11 0! the yeai the deduction is to be eflective. J� I Q jj �Q Q 8
2J Mob�7e Homes assessed under IC 64.7-7: BeAveen January 15 and March 2 of Ihe year the deduction is o lie eA�'cL e.
See reverse side for additional insWCtions arM quali�cations.
App� nt erufwraraddryei-seere ' �msmreverseside) GIBSONCOUNTYAUDITOR
n. I
legal
Assessed rdue of real popeM1y as d Mardi 1, ament year
record is dA(erent Ihan ihal af applicant, iMiple belav:
Name of mortga9ee or carNact seller
Address of mortgagee w con�racl seller (m]rnber a`Ttl st
Name of assi9� a dher owner w hdder af matgage
(mmrder and sLeet, dty. slafe. and Z/P mde)
�— �• ���� �� /J
ConVatl indeMedness unpaid as of March 7,
someme
ReooN
Is Ihe appG�nt Ihe sde legal w equitaWe wmefl
❑ Yes ❑ No
spouse, indicate wilh whom.
Is Ihe property in quesUOn:
❑ Real Prooertv ❑ Mobile Hane (IC 61.
�%/'��p 1
DI':115'Cl" �'�... JOCWO .I.....
Does applicanl o.m poperty in a,ry dher If yes. whal counry7 Whal Ta L9Q K�MY
caunryinlndiara? C:1I�(� �Q.�..•.'.�.�.J J,,,].�...... ❑No
❑Yes ❑ No
� �.'iC1Y. �