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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
s =—..
� FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm C3709 (R71 / 6-09)
�' ,.,. Presaibed by DepartmeM of Loral GovemrtrerG Frence
File Mark
INSTRUCTIONS: 1
To 6e �ed in person w 6y mail with the CountyAUditor or Counry RecoNer of the oounty where the property is locat�U L 1 with:
Fdirg Dates: fJ Real Pmperty: Musf file during the year lor which fhe deduction is soughL Coun AWitor
2) Mobde / Manufactured Homes not assessed as Real Property Must file during fhe hvelve (12) mon�3�' Ty
6efora March 37 of each year the deduction is sought. County Recorder
SeereversesideforadditionalinstructionsarMqualifications. GIBSON COU TOR
', AooFrant (ownerorconlydC buver s �esb'r�ons m rever� si7e1
� a ��a��,��/^�ap�o3-o0�. s�s-o.�8 ��oi� P�2�?�
: d rea1 wuaero as a �� ca,o-w iwectea�ss u�oam as of nr«�qage � ca,rad maeMetlness �mpaa as of h me eoaf�n, ure sde
n yrar Ma t, wne(y(,ye/.��S '\ date of appfxation legal w eQuita6le ameR
V 1. � O V ❑ Yes ❑ Na
m
Name ol rtnrtpagee or contraU seller
AOdr� of mortgagee w wntrad
Ooes appli�nt wm poperty in any i
counry in InOiana? ❑ Yes
'Es��i::9
sf+eet, ciry, stafe. aM LP cade)
someone ottrer than spouse. iMifate wiih whom
Is Ure propertY m QuPStion: Mnually AssesseE
❑ Real ProPenY ❑ ��Y �
.DI':i1V'�I" 1��0.. �J
;':�..•.....
qry, 5bte. and ZIP code)
IxiJ II.S :�Cal'(�1�'Q� � � .
ItYeS.xfiatcount�17 WAatia�d^9 • ,, � Qy Mr .I,�1 1' !... b
❑ No t ` '�',O IiKiII. � � No
�
20 � 20 � 20
2b � 20
I/ We certify under fhe penalty of p�f( ry that Ne abo�nd (oregoing informalion is true and correct a`W ihat the apDlirant is a resident of Iridiana and
owner I mntracl buyer of the aforemenbonea prope n date applicalion is filed.
�fa (o�meh hdl reme) Dare (nmlh. daY. YBa�
I�C/ / a t (num6eiaM street. dry, state, and wCe) , . � . " ��� ��
O
rsan autMf¢ed by d execvted of Aitorney w by IC Gi.1-12-0.7 Date (m�onth. daY, ysa�
Pddress of autlraaetl person (numDerartl sbee; dty. state.