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"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yea
_. ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn 43709 (R71 / 609)
�,,,, � Presa�beE M DeP�M o( I.afal Govemment Fi�xe a
p Ftle Fila7k
INSTRUCTIONS: �{ IH II�
Il o�meawan:
To be fiied in person of by mail with the CountyAUditof or County Recofde� o! Ne counry where the propeRy is located �
Filirg Dates: ij Real Pmperty: Must file during the year lor which fha deducUon is sought. � Counry Auditor
2) Mo6ile /Manu(actu2d Homes not assessed as Real Prtiperty Musf file dudng the fwehre (72) month� C T Q L � �
6efore MarCh 31 of each year Ne deducGOn is sou�h[ ❑�nty Remrder
See reverse side 7or additionel instrucGOns and qual/fications. C.'�. Iv�; �.,�
IM (owrreror mn7rarY buye� resLirlions m� sitla) v`\
' �-Q/ GIBSON COUNTY AIIfIiTlla
i, Tad fiG , KeY number / legal OeSC�iP� RecotC number Page numb�
��
11 no. what 5 his ! her e�md share af intrlrst?
m
Name of rtvxtgagee or conttact se0er /
S
Pddres of mMgagee a mnbad se0er (nwrl
_osyouo - 000. �8Y- oa � o� � SaS�
ge / Conbact indebte0�ress unpaid as d hbrt9a9e I Con� intlebteAness unpaid as d Is Ihe ePW�t Ne sole
M 1, arteM year date of apptintion legal or equitade ameYl
pQ [j ❑ Yes ❑ No
tl o�metl wiM someone other than spouse. iMicate wIN whom
'. uWitate below. 15 tl�e DroOertY in GuesEm: Mnu3Ay ASSe55e�
❑ Real Propetty ❑ AnnuallyAssesscd . . _.
stree4 cih;
rvame m assgnee w omer owner or naaer rn rtprtgage
na saee4 �: siaie, ano cir coa¢)
s-�- lo a
any oUer It yes, what muntYt
° �� � o��z
Dra���er NO: a� ��.........
- 5aso
c:,��� �o . . ...........�.....
5�3 6� � 85��. —
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