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^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T�
__ � FOR DEDUCTION FROM ASSESSED VALUATION
. � State Fwm 43709 (R71 / fi-09)
•� t p�bed by OePartrtrent of Lacal GwemmeM Fuiance
r� F.
INSTRUCT70NS:
To be fiied in person w by mad wifh the CourrtyAWitor or Counry Recorder o/ the counry where the property is located. Fartn 1
Filirg Dates: 1) Real Pmperty Must file dunng fhe yearlor which the deduction is soughL N O V 9 �
2) Mo6de /Manufaduied Homes rrot assessed as Real Property: Must file dunng the MreHe (12) monfhs
6efore March 31 of each year the deduction is swyhG - C�
See reverse side for additional instnicGons arni qualihrafions.
Apofi�t(o�merwcontrad6uyer3eerestrc8ons�varseside) � \ .7 � `� GIBSON COUNTY
/f i'1 �. 1
Key mmi6el / kgal desaiption
�-Id-oS -�vo-000,
Mortgage / Contract 4debted�xss unpaid as of Mary
�.larch 1 artem year tlate
�r:
nartie on recnrd's dRurnt Nan that of app&anl, uMirate Eebw;
r�a� or morteae�
neares ot mor4jas� «m,vaa
omer owner w nqaer ot mwtgaga
CJ2.._�
aM LP oode)
P40 m as9g�rea (numnar arm suaet �ry, s+ate, ana uY cotle)
� '
Dces ePW�nt rnm property in any other If yes. what muntyl
munry in IM�ana? ❑ Y�
❑ No
Year
Counry Auditor
Counry Recorder
�i 3S o a -7 �b �� P�39 �
�e / ConTa� indebtedness unpaiE as of Is Ne appOrant ihe sde
aPP�"�� 3.S 00 Zi �aeWdableowneR
�f n Yes ❑ No
�T_�_
What Tapry Datric[7
spouse� u�dttate �vWt whmn
OursOm: awiaOY Assesse0
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uUN� -�� �
IQ�1 AE/rJ
�a -,�,03
����w�4�....� N�.�wy
tar wrrent Y�n ❑ Yes ❑ �.