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"'�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_. • FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 609)
� Presaibed by Departrne�n of Loral Gavemment Fi�rce
�«.
File Ma
lNSTRUCTIONS:
b be lled in person w by mail wifh the CountyAuditw or Counry Recorder of the co�nty wheie the pioperry is bcated.
Filirg Dates: 1) Real Property: Must file durirg Ne year /or which the deducfbn is sough[. un Auditor
2) Mobde / ManulacNred Homes rrot assessed as Real Property Must fiie dunng the fweNe (72) months ��- Ty
betore March 37 0/ each year the deduction rs so�ghL Cou Reoorder
\
See reverse side foradtlitional instructions arM qualdications. GIBSON COUNTY AUDITO
Appfi�t (ox+rer w�vaa buyzr' � restriraais w�reverse�a�e) A n e
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Marth 1. armnt ym
It ro. what ts his / her eract share oi interest?
narrie an
Name of rtnrtpagee or contraG sNler
nearess oi ncrtgayee «cmaaa
Name W asslgnee a oNer owner or twlder at rtqrtgage
-3a' �oo_ o�v- �o/-
3/ Cantrati rtW�teOness unpaid a W MMgage 1
a�rrent year date of ap�
AGtlress of assignee (numDer arrtl sfreet tlry, state, an0 Z/P code)
I �L
� llra�ver NO.. c�0ia...:. —
� Card \O. .. �.o�..�.�:.:.:...
� yl,oa�.°° _
Sigrewre of Counry Auditor
zo
sameorie
What Tadrg Distric3?
zo
� � .__._ia .�"�
rut inCe6tedness unPaid as d Is Ihe ePPfiont ihe sde
legal w equitahle m�nd?
� � ❑ Yes ❑ No
icr ihan spasse, indrate with whom
Is C�e DroO�Y in aueetion: MnuaM �sesse�
�iteal ProPehY ❑ ��!�Y �
- / _ ��
Has Na dedutlion been reQUested on property
forcurtentyeaR
❑ Yes ❑ No
2� , 2�
I I We certify under ihe penalry of perjury that the aDOVe and foregoing infortnalion is We and corteG and [ha[ the applinn[ is a resident of Indiana aM
owner I contracl buyer of the atoremerrtioned property on date application is filed.
�� (awneYs hAl nartre Date (monfi, day, yea�
�1, ,� �� o R� . . ,� 9- �/ - ao��.
Person auNO�aetl
sLeet, dty, state, aM, J�P code) �/
S ��� /I/ /7Q-� �
person (numbereMSheet,
by IC 67.142-0.7
�
Date (monfh. daY. Y��
_ _ I
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