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^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS co o Year
�,__ � FOR DEDUCTION FROM ASSESSED VALUATION
�• Siate Folm 43709 (R77 / 6-09)
�,�,� � P`esaibed by DeP�M of Laral Gavemrtrerd Frence
�isrnucnoNS: � MA���
Fwm filed wIM:
To 6e �/ed in person w by mail with the Counry Auditor or Counry Recorder o/ the counry where the property is located.
Fitirg Dates: 1) Real Property Must rile during the year for which Ure deduction is soughf. C�' n ,ou' Audimr
2) Mo6Re /Manulactured Homes rwt assessed as Real Property Must file dunng the hvelve (12) months
6efole March 31 of each year ihe ded�clion is sought ��
GIBSO CO TY AUDITOR
See reverse side 7or addifional instructions end qual�cati�ns.
( roroonY�rtDuyer' ^snKtprtson e) � A
Asse�etl vehie af mal pfopaty az ot
Mamh 1, cumrt year
u �o, wna� is na r rrer e:aa
on
0
!A��ge � cono-aa indebt
Mamh 1, artent yeer
aDP��I �dinte bebw.
rtnrtgagee b mnUarl se9er L�/�
O�
�CC Of Cdlff3tl SP�¢f
Name al assignee or ottw! awner or hol0u o( mortgage
Address of assignee (num0er a� slreef, ary, state,
Dces aPP�nt wm pmperty in any aNer
munry in Indiana? ❑ Ye5 ❑ No
20
approved in ihe amount oE
20
ce; riry, state. aM ZIP m0e
Z/P code)
��,�.��W��n
�o�
2�
.600_ o-GG9
unpaid as ot Mw�qage I Con'rap indc
wna� ianng ursmar
�
e
�b o� P% �3�
�spaid as d Is Me aPP���� ihe sole
legal a epulMable ownM
❑ Yes ❑ No
:' `'fc'
�e property in VuesUm: Mnua�y Assessed
Real Pfoperry ❑ Nmually�
�R�-' ���z�.��.�
RsTA J
01- �'7,35
�i: v�d
I/ We cert'rfy under Ne penalty of perjury Uat Ihe above and foregoing infortnatlon is W e and corteU a`W that the applinnt is a resident of Indiana ard
owner I conVacl buyer of the aforementioned property on date application is fileA.
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Vv0.�
\ FW�resident��e5+ um6er�
X P
Psson auttn�¢eE Dy dNy exewtetl Power
Ad�ress ot aNhor'¢e0 peison (number aM sfraet dN. sbte, an0 ZIP codej
z� �-��39
Date (month. daY• YF