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^'�o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
F��,_ = FOR DEDUCTION FROM ASSESSED VALIF�C�J� �
~ State Fortn 43709IR71 / 6-09) �N xa
S„� ? pRSrnbed M�P�ent ol Locai Govemment Fina¢e g 1
File Mark
INSTRUCTIONS: nI(7 7 �'n
To be filed in person or by ma�l with the CounryAUditor or Counry Recorder of the dd8h� udhere �7 �perty is located. F� �� ���
Fdirg Dates: 1) Real Property: Must file durirg the year /or which (ha deduction is so{yht �Counry �tnr
2) Mo6de /Manulactured Homes rrot assessed as Real Prnperly Mb'shfileRi�A���5e.qveAre (12) months � County Rewrder
6efore March 37 of each year Me deduction is soughG J`\\
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Seereverseside/oradditionalinstructbnsandqualifications. GIBSONCOUNTYA
Appfimnt(ownerw b ee mreM e � oO�
T' istrifs ' Key manber / le9al eesaiptim .. . RecoN num0er PaBe numbrl
- co- a5- o-c� . q56-o o�a 3�
As�ed value � as al Mortpage / ContraG indehtedness unpaid as of Mortgag PP �� udebtedneu unpaid as d Is��eor equim6le a�me(1
Marri� 1, aarent year Match 1
�(�f�l ❑ Yes ❑ No
ha / her exaG share ot interest?
If name on record k mEUent Nan ihat
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AEd! � .w �nUrtlbCf dfld
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state,
IP cade)
�s u,e omaem �� a�,: a,��eor asses�a
❑ Real ProPeNY Q �!?n!all):A�e��d
Does eppli�nt ovm pmperty in any oNer If yes, what mun �Mhal Tad Oistrict? Has Ihiv dedud'wn Deen reqursted m O�Y
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munq m IndFana? ❑ Yes ❑ No lor artent yeaf! � Ye5 ❑ No _