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,.t ^�*.o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
k��' 4 FOR DEDUCTION FROM ASSESSED VALUATION
%� �+� State Form 43709 (R71 / 6-09) 51 2012
'��= Presuibed by Departmeni of Local Govemment Finance ��F1le�f�
u.
INSTRUCTIONS: �LJ
To be (1led in person or by mail. orm filed with:
Filing Dates: 1) Real Property: Must be completed and dated in Ihe calendar year for which the deduction is sou9hG S� li-�no �%
Musl be filed with fhe County Audilor or County RecoMer of the wunty where the property is located u LOC.'OUnty Auditor
on o� befo2 January 5 ollhe immediately succeeding calendar year. C. , m. ounty Recorder
2J Mobile / Manufacfured Homes nof assessed as Rea/ Property: Must file with lhe CountyAUditor o! the
wunty where lhe property is locafed dunng the Rvelve (12) months be/o2 March 31 0/ each year the V
deduction is sought. GIBSON COUNTY AUDITOR
nvneror contract buyer see restnctions on reverse
L. Sollman and Amanda M. Sollman
����
�ssessed value of real property as of
Aarch 1, curtent year
I no, what is his / her exact share of in
f name on record is diRerent than that
number / legal description 26-17-26-100-000.136-021 / Property
W. 850 S Cynthiana, Indiana 47672
PIN
26-17-26-100-000.136-021
ie ot mortgagee or conVact sener
3nsville Commerce Bank
ress of mortgagee or contract seller (�,i
N.W Fourth Street, Evansville, IN
ne o( assignee or other owner or holder
and street, ciry, s1.
licant own property in any other i
Indiana?
❑ Yes �'
20 _ � 20 _
1, curtent year
I I We certify under penaliy of perjury iha
owner / contract buyer of ihe aforementioneu�p�
W. 850 S, Cynthiana, IN 47612
person
�`-� I � '
Attomey or
as of Mortgage / ConVact indebledness
date of apP�iwtion
med with someone olher lhan spouse, in�
���� �-
a/� i�%3
�aid as of Is the applicant the sole
legal equitable ownen
Yes ❑ No
�e pmperty in quesnon: nnnuairy nssessea
Real Property ❑ Annually Assessed
Mobile Home (IC 6-1.1
; this deduction been reque ,ed on properry
current yeaR
Yes ❑ No
20 _ � zo _
day, yea�
3nd that the applicant is a resident of Indiana and
Date (monf�y, y� � / �
�
day,