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.f °'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (RS / 2-07)
S � 1 Presvibetl hy Department ot Local Govemmenl Finance
INSTRUC710NS:
To be filed in person or by mad wdh the County Auditoi o/ the coun(y where the propeAy is bcated.
Fd'mg Dates: i) Real Property: Dunng the 72 months belore June 17 01 fhe year tha deducGon is to be e�fective. A�D-
2) Mobile Homes assessed undei IC 64.7-7: Behveen January 15 and March 2 0/ the year the deduc6on is fd1�b tltte2fi�.1 �(J a
See reverse side (w additional instructions and qualifications.
LiU ,! �� �- Key twmber� Iega
�A'(�.�r/JU �la-�� /
rdlue of re:l popaly as of Mardi 1, arrenl year
exacl
reme
Nat of applicant, i�ote below:
Nartre af npr�gagee or cont+acl seller
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Comraa indeMedness unpaitl of March 1,
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Address of mortgagee m m�uact seller (numjfyF and sbee(. dty, 4ate, arid ZIP code)
Name of auignee a olher awner or hdtler of mongage
Atldress of asvgnee (num6er arM sbeeL dty, sfate, aiM ZIP wde)
oaes appi�an� v«n propeny In eny aner u yes, v,n,
caunry m Indiana7
❑Yes ❑No
DeOUCtion apprwed in the amwnl of:
zo 0 zo 1�_2 2° —
If owned
GIBSON COUNT � � �
R numb�� Page �
0
�s �he appGmnt �he sole legal w equitahle o�me(?
❑ Yes ❑ No
spause. indicate with whom.
Is �he property in quesUon:
❑ Real Pmperty ❑ Mobile Home (IC Cr1.7
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a''� �Ci��-w--�
��N �Gb� -�5"G � � �7
_ (f.,���,�u� 1`� " 8� � o a
0\
p ,
�s�� o� v�aem
❑ Yes ❑ No
Date (monfh, Aay, yea�
zo
I I We certify under the penalty of perjury ihat fhe above and foregoing infortnation is true and correcl and Uiat the appliranLS was I were a resident of
Indiana and owner of the aforementimed property on March 1, 2p
i�wa (owners r�si��� _ , Date (manfh. daY Y��)
aeL dly, sfate. and ZIP code)
sr �R,n�
w by IC 61.1
Address of aulhor¢ed persm (number an0 sfree4 a}: state. arM LP wde)
Date (mmlh, day, yea�