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��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u To Year
��' _ s FOR DEDUCTION FROM ASSESSED VALUATION p�
• State Form 43709 (R71 / 6-09)
�' ,,,, Ravieed M Decartniem o1 Lora� Govemmem F'irence ;
wsraucnoNS:
N�V F'e ark
To be filed in person or by maii wiN the CountyAuditor or Counry Recader o/ the coun where the F� �� ��
b P�aertv k kcared.
F�irg Dates: i) Real Pmperty: Must file durirg the yearlor which fhe deducLOn is soughL �o un Aud'RUr
2) Mobde / Manulactured Homes not assessed az Real Prt�perty: Must file dunng the fweNe (12) months . /.�rz, ry
6efore March 37 of each year [he deduclion 's sotghL C40nry Remrder
GIBSON � --
See revarse side for edditional insfruclions arM cual�ncafions. '
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BIC�1 i. f1I1CV )T.8! �i. 0.1fR(1� )'PJ
�
no. wha� IS hi5, t� 8�U Shara of Nter�
�me m ramtl e dtlte2nt than ihat of aDP��. mCinre bebw
ama d rtnrtomea or rontraU sWer
Addrea ol rtnrtgagce & cfntratl sy� (numbrl and
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Name W azv�iee a aCrer ownet n hal0ei d mortgage
AEEress ot asseyree (numberand shee4 �Y. smte.
ooes eow�m o� vuo�r �+ any «n�.
�,My � i�e�?
❑ ves ❑ No
DeEuc6on apyweE in the amount of:
20 20
SgraNre d Camy AWitw
straeL �Y• sAte. ard LP cade
aM LP mtleJ
rc,�. �� �,�
COU
20 20
Retord numDer Pape numCel
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I/ We certi(y under the penalty ot perjury that Ne above and toregoing intwm<-,;�� u m�.� end mrtect arM that the applicant is a residerrt of IMiana aM
owner I contraG buyer oi Ne aforementioned property on date application is fileo.
s of a (number and sfreef, rily, sfata, antl ZIP ooCe)
ZO �-ou � oon D✓ P�u�vice�+✓, fJ✓
ry duy ezewted Power MAtmmey or Cy IC 61.1-12-0.7
DM'..on (n�mberand sbeeL �1: SYdR. erM ZlPCOtle)
o�e ��rn. aar.