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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip Y
. FOR DEDUCTION FROM ASSESSED VALUATION
51ata Form 63709 (R70 /11-08J J
` � Rascribed bY �M�ent d Local GovammaM Finanm
INSTRUCTIONS: FrbiAl�rkl g ZDOJ
To 6e filed in person a by mad witlr the Cour#yAud#cr d the caunty wltere the poperly is bcated.
Filing Oates: 7J Real Property.� Must file dwing fhe year for which Ne deducb�on is saight. �
2) Mobde / Manulactured Homes nol assessed es Real PmpeRy: Must file dunng �e hveNe (72J mmfhs 6e%ie Mar��lea�
the tleduction is soughf. �
Seereverseseeforadditionalinstrudionsarrdqualifications GIBSON COUNTY AUDITOR
MP�3P (m.nerm coirtlad drysr�me s m reve�s5.�) . _ � _ / . _.
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March 1. mreM yaa
Y ro. what a h¢ / har axatl ahare
tl mme an recad's dAeieM Ihan �hal af aGV�4. rtdimb babr.
Name d matgagee ar cwtrad se0er
`mfiga9ee
9
Pddress d assignae (num6or and sbee4 �'dY
�a�t�����
wmty m IM'vre1
❑ Yes
.-�.i��z��
�_�
_ ODO. 7 /�a —D d-� ��
ss unpaitl aa o( Mortgaga / Cantracl indabtedness unpaiE as d Is IM
� EataofappFtation legal
someone other Uun sV�+sa. 'vdkate wiN Wran
D,-�,,.�,-.o.. a o09
..............
Card NO. ....".�.��I�P.......
ZO I 20 I 2(1
iRable wneR
Yes ❑ No
Is ttia P�oeRY in Vuastian: AmuaOy Assessed
� Real PropeM O Mnualy Assessea
Has IhiS de0uGi0n been reVUeiied on P�M
(w arteM yeaR
❑ Yes ❑ No
20 � 20
I/ We certify uMer the penaity of perjury that fhe above aM foregang mformatan is We and correG and that �he appliwnl is a resident of IMiare and
owneJ / mntrar2 buyer of ihe afo tbned property an date apptirafbn is filed.
1^� '+ ).? i _. Oata (monlh. daY• l'�a�
[J
asealetl Power d Anomey ar by IC 6-1.1-12-0.7
Addrass d au�honzed Parsan (numbrranE swet dq: s�te. an0
Date (mmN, day,