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""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T rear
_ FOR DEDUCTION FROM ASSESSED VALUATION
State Fam 43709 (R70 /77-08)
� � Presaibed Ey OepaM�ent d Lool Governrterit Firuim
rrrsrnucnoNS ,JUN �de n�a�09
To 6e filetl in person w by maB with Ure CountyAWilar d fhe county where the popeRy is lxaled.
Filing Da1es: 1) Real Property.� Must file diuing fhe year /or which Ure tleduction is sought. �/
2J Mobde / ManulaUured Homes not essessetl es Real Properly.� Mus! fde Ouring tlie hveAa (12) mmths 6ef�A/ercli�AR 3rh year
the detluction is sought � �
SeereversesideloraddCbonalinsWdionsandqualficaGOns. GIBSON COUNTY AUDITOR
Mo4wnl (o m mNiat( Mmlr- see iesbiCions m rovrim sidnl
rr / iepal darription
-/a,-o'7 /o/-
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tl ro, wfut is his
Y�ma m record'a d�erarn ttan Ihat o(
ongaga"e o,r, m��vtlrraU�{eAer �
����i'ivr+� -Lf%
mongagee a mvraa saoar (m.,NC.am sfreet �r, sffia
v
Addrass d asignee (numbor an0 sbee4 mY abh; aiE LP m0o)
Doa^ aPG��t own proparty in arty olher I H yes. Mat murtly?
counry in IMiare? ,
❑ Yes ❑ No
zo � zo � Zo � 20
� � 9 0�8 R��o �a 88
7a / Curtracf indebtedness un�aid as d Is the appGqrtl Iha sda
aCP�tion ' legal m aO�Rable awneR
❑ Yes ❑ No
with someone ather Ihan sw�se, iMirate wifh whm�
�
�
ks the praparty ui puaCim: Amm�aOy Assessed
�RealProperty QMnualyAssessed
.�� i�i�el i —
�\0...��b9
w�ra�p� /..... "'�
C:lr(f I�;O ' °�k'�'( .. ] No
',�,'K ., UU _
\UOfTOR � _
��a�a��
��s��;r,
i/ We certify under the�alry of perjury ihat the e and (wegoing mtormation is We and cwred and that Ne a�ran[ is a resitlent of indiare arM
owner / mnhatl huye f tlie aforementioned rty on date applircation is filad. �
�natu�e i9"^'�3i�S9� ^a^.'�) �� " Dace (morW4 tlaY. Y�/i
aulhwrsetl by dWy asaculed
��
w by IC 6-1.
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