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^'n STATEMENT OF MORTGAGE OR CONTRACT INDEB��ESS Coun 7ownship vear
FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fwm 43709 (R71 / 609) 11 .
•�' Presaibetl by Departrtre(ri of Lacal Govemment Fuunce JL..J
File Mark
wsrRUCnoNS: SEP 2 7 Zp�Z
To be �led in person w by mail with the CountyAUdito� or Counry Recorder of the counry where fhe property is located.
Fi(irn� Dates: 1J Real Pmperty: Must file dunng the yeai for which Ihe deduction is soughL C �. ry�„-�� `
2) Mobi(e /Manufactured Homes not assessed as Real Property Must file dunrg the tweAre (i19J months
6etore March 37 of each year the deduction is sought. V<' \
GIBSON COUNiY AUDITOR
See reverse side (or addrtional inshuctiwu and qualificahons.
�'°°� t�(owner\arcontrarl6uyer-see��� drieverseside) q�—t- o �
`X.oA,nn.. L -F- Tn��Q.. ��.n lmh'n1nJ�f
�
Mafdi
tt m. whet is h'a I her e� share ol interest?
artent
If narne on recad'a dfiuent Ihan that of aPp6mnt, tr�dirate beloxc
�� a �o-�,
other owner w hdder of morigage
Fa,n m�a w�,n:
�Counry Audimr
Counry RecoMer
Retard numbu
�, appArant Ne sde
w equlta6le an+ieR
❑ Yes ❑ No
I( o�med wiN somearie other Ihan sPOUSe. irW-icate witl� wFrom
Is tice pmperty in Vuestian: MnuaM Assessed
���v�r O?!?�!�M�
cM sfafi. ard LP crode) �'..I IL� �r � J�� �
.{�U�p 5�
(numbe� aM stree4 �y. swe, end ZIP cotle)
Dces applinnt a�n property in any ot�er I If yes, wha[ county7 I VJh:
wunrymintlau? rl .. I-1 ..
l�? - �I855 �,
R7
COUNTYAUOROR
Deducbon appmv�.-0 ui Ne amount of.
20 20 20 20 _ 20 _ 20 _ 20 _
Sig(awe N Caa.ty Aueitor Caunry Date (mon@r. daY. N��
1 I We certify under Ue penalty of perjury that the aDOVe and foregoing infortnation is true and cortect and that the applicant is a resident of Indiana a�
owner ntract buyer of the aforem �rned pmperty on date appliradon is filed.
Signa (- /sp hdl nartre) � Date (monfi. daY. Yaa�
�[�l�--
Fu0 resident eEA'ass oi appG�ant (wm6erand sbee4 dN. e, anA LPCatle)
(,�/�Uq E 35a N kCrsco /ti 97Gg�j
Pelson auNOrized ty duty execvted Power af Anomay or by �C 67.7-t2-0.7 Date (rtanlh, tlay, yea�
Address of auMa'¢ed person (num6er aritl stree( firy, uate, aM ZIP code) .