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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
- FOR DEDUCTION FROM ASSESSED VALUATION
" ' . ' Slale fortn 43709 (R11 / 6O9) � � � ' �
S y,� � PfeW�bed q' OeP��M of lOfal Gwemrtrerellt Fi`w¢e _
File Mark �
INSTRUCTIONS:
To be fi(ed in erson a 6 mad with the Co Auditw or Coun Recorder o/ the coun where the F�
a r �r ry N woae�N is bcated.
FiTirg Dates: 1) Real Property: Must file dumg the yearlar vrhich the deducfion is soughL ���� q��
2) Mobde /Manufectured Hwnes not assessed as Real Pmperty: Must file daring the fvreNe (12) months C�-�'h�-•-y
6efore March 37 of each year the deducinon is sought ❑ Co �Ty `w�rder
Searevers�side/ofadditionalinstrucUonsarMquzli�cations. � GIBSONCOUNTYAUDITOR
Ap ° Iwcontyerl6�'searest�arnrever�sida)� n �l A /1
�
value a1 rral pioperty as
1. aarent year
If no. what Ls Ns / trer exaG share
��a.� �f�n � ir, i ii i.
It nartre on rcworE's dMereni Nan Nat of aPpWant, 6Wicate below.
Name of mortgagee or
���
��
i of assignee w Uhu ownu w hdder of mortgage
rs5 of assig�e (number aM a7ree; r�ly, stete, and Z/P cotle)
epp��ant wm p(operty in any oNer I( yes. wha[ munt�/1
yinlrWYana7 � Yes ❑ No '
couNn
� aac�� m ure ammmc ae
2� _ 20 _ 2� 2a _
az of MMgaqe I Contract rtWebtedness unpaid as o( Is Ne appfinnt Ne sde
date of app�tion legal or equifa6ie ovmM
��' �r � ❑ Yes ❑ No
� wmed wi� someone otlrel Nan sW�. kdkate WN whom
Is ePrapertyinquwbon:MnuaMASSessed
RealPropeM ❑lvmua�Nwssessed
r�.�ow� r�ome nc �t�-,
What Tadrg Dstrict7 __I Has Na deduGion been
SCI% � � f�' 01�j L.
L�L-1NS�u-c 2
�a- 4sea
1 I We certfy under ihe penaliy of perjury that Ne above arW foregoing infortnation is W e and correct arM that the appfirant is a resideni c
owner I contraa buyer of the atorementioned property on date appiicaCon is filed.
� (owheYs fi� r�ame) ��\l . Date (/mrRh. daY. Yg�
� LJ \ � �� � � '
FWI resident @dArass of appfrcant (number aM sLee4 dty, state, arM LP mdeJ
� l a E,4utU�v��i H u aoC+ �J �-I��o
Person author'¢ed by OWy esew:ed Paurer of , y m by IC 61.1-12-0.7 Dare QreonN, dzy, }ea�
pvson (numDaraM sbee4 Cuty, sbte.
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D�rtY
and
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