Mortgage_Baehl (7)"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (R71 / 6-09)
�' y,. � P�esm'hed M�P�eM of Laal GwemmeM Fu�arce
Ile
�7RUCT10NS:
To 6e filed in rson w b ma�l wrfh the Cou A Witor or Coun Recorder of the coun where (he ro Fam med wiw:
Pe Y ^lY ry � P PQnY is located. E� �tfi 1��
FiNrg Dates: 1) Real Properry: Must file dunng fhe yea� for which tha deduction is so hL L� Auditor
2) Mo6ile / Manufactured Hanes rrot assessed as Real Property: Mus! file dunng the fvmlve (72) months
belore March 31 0/ eacA year fhe deduclion is sayht nty Recorder
�.
See reverse side /nr additional instructions end qualifications.
Ap o.mer orcontraC buyu- sGe msLiCions m rerr+se siie) �
� �,�T �y,� GIBSON COUNTY AUDITO
Taryg DistriGn ) Key fumiher/ desaiption �fy �y� Pape numbrl
-19-/9-/oa-DDO, Da�!-U �
�����
Marth 1. �vmit Year
If m. vfiat is his / her euG share or
tl narne m recnd is dtl[u�t Ifw� Nat af app6c� uWicate �ebw:
�����a����7�Fc
oMer owner or hddar of mwigage
of asdgnee (numbar and sheeL �: s+ete,
�'r �t.J 19_3-
applifant wm property in any other
y in IMana?
❑ Yes ❑ No
artpunt
zo _ � zo
Y�
o,
� ,�o �-�
If yes. what muntyt What Tarifg
zo _
1 irdebtedness unpaid as of
q8, �oa
m� �. ��� wm �
r� u No
�b properry m Ques6on: MnuaOyASSessetl
E� �fO�EKY ❑ AN11121yA55e5�
MoW7e Fbme (IC 6
�p►t N � � SCt> if- ►�"
lnE�� � �
/ �— v.71��
� �a1�V.%LL(-: �%}' �%'�.s
zo � ����=- �k�� ��•R%J,J
�ry � R�' ��o�
I I We certi(y under the penalty �ierjury Ihat the a6ove arW foregoing infortnation is W e
owner I contraG buyer ot the aforementioned p:7�erty on date apPfication is filed.
3 re(owne/s NO I�(ne) , e '
ff � KX/% �
m resideni adCr� of app�rcant (numEer aM sheet tlry, state, ernd ZfP code) '
�i17�, E„sL St/a�n S�,�oi .�n�+ l��udcl� . Ll�i �-1
Pddress of aNhor'¢ed pelsan (numDer antl sbeeS �: sbte. aM Z1P coda)
Oate (month, day, yea�
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