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'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun ra�
FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Fartn G3709 (R71 / 609)
4` f presoibeE by Departmenl af Local Govemment Frarxe
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wsraucnoNS:
F«,� m�
To be filed in person w by mail wilh the CountyAudifor or County Recorder o/ the county where the property is located. o
Fiiirg Dates: 7) Real Property: Must file dunng fhe year for which the deduction is sovghL S E P p@
2J Mobi/e / Manufactured Homes not asseued as Real Property Must file dunng the M1velve (12) months
betore March 31 of each year the deducfion is sought.
C .'J.IY
See reverse side for addrWnal instrucUons arM qua/fications. `�
qp (mmerorcavraob�uYyer-seerestnceonsmrerelseside) GIBSONCOUNTYF
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Tau�g D' ' Key num6er / kgal desaiption , RecoN numbrl
oZ(o - I -I 9-.�-03 = oo/. 3 3- o l. o�1
Asse.ssed vdue d real qcperty as of Mw(yage/ Contrau 4We6tetlrress unpatl as W Mortgage / Con� intleb[eAness unCaid as d
Mardi 1. nrtrnt year Mamh 1. artent year date of appOfation
I SS.00C7
If m, what is h'a I her e�ct share of intr,rest?
If reme m remd is Srtfuent Ihan Nal of appl
t�,-� — w���/ �rC
gce or mntract seAer (number end sbee; cify, smM. and ZIP
w other owner w hdder of morigage
Atltlr ofassignee numDererMs
7J�c.�
applipnt ovm pmpeM1y in any
counry in �nd'ana? r-i ..
�
I/We
appioved'ui the amount of.
�
Pr ,� .E
If yes, what muntyt
�_ _I_
�9- 3 - lo
What Tadrg D�st`iU?
COUNTY
Fn
untler Ihe penalry of p�fury that the ve arW foregoing information is I
ad buyer of the aforementioned prop on date application is filed.
STJ
state, aM LP
person (number aM s�ee; ary, slate. arM LP mde)
Year
Counry Auditw
Counry Recorder
ITOR
Page nu �
3 ��
appfifant 1he sde
w equifehle v.meR
❑ Yes ❑ No
Is the OroPertY in Westion: MnuaM Assesed
❑ Real ProPeAY ❑ Mnualy Asse55ed
Modle Hart�e (IC G
Nas �his dedut]ion been requesteA an propelty
rw wirm� yea/? ❑ Yes ❑ �
�d�a
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ca�-a �o. ...��.. �
15�1,\e'� `�
Date (monN. daY. yaa�
Datc (monfh. daY.
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