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^'�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ � FOR DEDUCTION FROflA ASSESSED VALUATION
� State Folm 43709IR71 / fs09)
,,� 1 PresaiEed M OeP��nt of local Gwemment Finarrce �
INSTRUCTIONS: �
To be filed in person w by mail with fhe CountyAuditor or Cowry Recortler of fhe wunty where the properry is bcated. Fa
Fdirg Dates: 7) Real Properfy: Must file dunrg fhe year for which Ne deducfion is sotght Q T
2) Mobde / Manufectured Homes �wt assessed as Real Property: Must file dunng the twelve (12) months
betore March 31 of each year the deduction is sought. C�
See reverse side for additional instrucGOns and qualfications.
LUUOry Auditor
LounN Remrder
qppkaAt(ownerorconvaebuyer-se�rewrl,oncmreverses:fa) 9 i. GIBSONCOUNTY
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T ig �istrict Key number / legal AescriVtion
a� - _ p -200 - oo�• l u--o �
vehre d re� papeY,y as W Mortqa ge / ContraU inde6tednPSS unpaid az W Mor�qage I Contrad ird�
1. anrnt ytar Mard� 1. a�rtent year date of aPpGrat'v�
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tt ro, wfiat is ha / trer ezatl share of intuest? If awned wiN someone oCrer Ihan
If name on recortl 6 GHferent Nan Ihat o( aPP��t h�Gipte Gebw
Name of rtuutgagee or mntraa seller �
TF� u
Pddress ot rtartgagce or mntracl se0er (nurti6rl and stree; ri(y, state, arrd LP oode)
rvame o� assignea w omu owner or naver rn mor[gage
��assgnce nu iarMSt2e4aNstate,
� -y -
duant own pmperty in any oNer
Intlana?
❑ Ves ❑ No
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Rew`dnumbu Pa9enumbu
Sos
btedness unGaiE as d Is fhe ePP�^t the Sole
legal w equita6le amrYl
� Q Q ❑ Yes ❑ No
. hWiqte wM wMm
Is ihe pro7ertY in Quesfion: MnuaOy hssessed
❑ Re� �roaenv ❑ a�uaMa�sed . . _
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