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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ • FOR DEDUCTION FROM ASSESSED VALUATION '
State Fortn 43709 (R71 / 6-09)
�' ` Presrn'OeG by Departrrierd of Laml CawemmerC Rnaxa
Fi a
INSTRUCTIONS:
To be filed in persw+ w 6y mail with the CountyAWitor or Coun Recorder of the coun where the F� fl� �:
b �Y P�P�rtY is located. � .� ^,�
Fifig Dates: 1) Real Propelty: Must file d�rrng the year /or which the deduction is sought F B ���d �ry a,aao�
2) Ab6de /Manuladured Homes nof assessed as Real Property: Must Ae during fhe fwefve (72) months
before Mamh 31 0/ each year the deduction is sotnght. C. , �tY Rec°rde�
Sea reverse side 7or additional instrucL'ons aM qualrfications.
App�ny(qy»�ora�no-ertbuyer-sree rererseslde) GIBSON COUNTY AUDIT
Assessai raWe d real WaP�Y az d
'Marrh 7 armrt year
If ro. what is Itis / her ern] share ol
If name m
or contrarl seller
r/ legal desaiptim Recad num0er Page
o-i -o -��a-o�. -oa8 2-oia �9
Mrtgage/ Cantraa'u�debtedness unpaid as d Mangape / Cantraa udebtedrress �mGaid as d Is the ePP�� Ne sde
rM 1. artent yeer / Oate of appGCatim legal a eQURade owr�Nt
S(O S ❑ Yes ❑ No
M owned with sameo�re other Man sGO�. 4Nkate with whom
(numM! aM stree; ray, stete, and LP
Name M assignee w oNer owner w holdu M mortgage
Dces ePptifaM axn 7�P�Y in any i
counry in Indiana? ❑ Yes
in the amount oi:
�v� i5�- PT
If yes. wfisl munt/1 What Ta�drg Dislrifl?
No
COUNTYAUDROR
�_ � p_ � p_ � �- � �
Is ihe property in Vuestion: MnueDy Ascssed
�] Rea� Properly Q Mr,ualh� A�
MoWle Fbrre IC 61.1-7
� O � � _
5� �9
�=�ad � 58, (��I � o�
fm au�erv
p_ � p-
�riame d Coimb Auehw Counry Date (nnMh. tlaY• Y�h
C- r.
1 I We certify u�er the penalry oi perju that the ahove foregoing intortnation is true and cortecf and ihat Me applirant is a residenl of Irdiana aM
owner I ntrad buyer of the e' ed Droperty date apPlication is filed.
� � � ) � Date (nnntli, daY. Yaa�)
esitlmt addmss of appGCant number and sbeaf, tlry, slate, P cada) c�
��_a9 _�,�.:__, �� �'�,�4,..,�.z� -y�� � � C�
rson autfwrrsed Gy duty executed Prnxer of AtidneY a M IC 67.1-t 2-0.7 Date (rtronN. OaY Yee�
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