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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,_ _ � FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fortn 43709 (R17 / 6O9)
�' y�. � Presbibed by DepaRmeM ol Loral Gov2mmerLL Rflance ����
File Mark
INSTRUCTIONS:
Form IBad with:
To be filed in person or by mail wi�h the CountyAuditor or Counry Recorder o/ the counry where R�!�y u located.
Filirg Dates: 7) Real Properry: Mus1 !le dunng the year for which the deducfion is sou�� L�� [�J I1 unry Auditor
2) MobBe / Manufactured Homes rrot assessed as Real Property Must file dunng the fweHe (12) months
betore MarcA 31 of eacA year the deduction is sought. C,� Counry Recordu
See reverse side fnr additione6lnstruclions and avalificafions. �
�
, �s .�c — o�—
drdluem�pfope�tyesot Mwyaqe�crton_t�a Bi
� curcn Ymr Mard� 1, ai BafSR
�at fs his / ner er.act share ot interest?
m reootd's Qf,ferent Uun ihai of aPp6ca�
bebvr
Name of rtqRgagee or mntraU seller !
\
Address of rrortgagee w mntrad se�er (numbu and svee; ciy,
Name o� assignee w other ownu or hdder M mortgage
ACEmss o� assgnee (num0er erM stree4 M'. siefe, aM Z/P mC
axam wm
Intliana?
Y�.
ZIP code)
GIBSON COUNTY AU
RecorE numEer Page wmCu
J�(- � aS-° a� i�
i az af Mongage / ContraU "vNebtedness �mpaid as d Is ihe epp�xant ihe sde
\ Eace of aOP��� � w eQUitade ownen
J n Yes n No
If wmeC with wmeone aher ihan spouse, indirete with whom
Is the DbPertY in Oues6m: MrniaOy As=^-� ^�
�RealProperry ❑ArmualyA,sesSed
hbbile Fiort�e (IC 61.1-7
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