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""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS c 7ownsnip vear
�_ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-09)
S�.» , P��aibed M DeVa�M of Lacal Govemrtrent Finance
INSTRUCTIONS: Ffle Mark
b be filed in person or by mail with the CountyAuditw orCOUnry Recorder of the camry wheie the poperty is located. D IZ
Filirg Dates: 1J Real Property: Must file dumg Ne year for which [ha deduction is soughG County Audimr
2) Mobile /Manufactured Homes rrot assessed as Real Property: Must file dunng tAe tweNe (12) months C�
betore March 37 of each year the deduction is sought. ou ty RecoNer
See reversa side 7or addiGonal instructions and qualfications. G IBSON COUNTY A
Ap?Gfar�(°w�er or contract buyu'seF'�esLC� m revzrse si191 _ _ ' .
��' ' . � '
Assesud vaM1ie of 2al papenY es of Mortgage / ContraG 4dehtetln�s unpaid as y Mortgaqe I G
Mardi 1, arrrnt Y� Mar� 1. a�rtent Y� tlate ot aDP�
�
It �a. whal is �a I her ernY share of interest? I( owneE wiih someo�
tt name on record is Eilfuent than Ihat ot aPP��L "uWinfi Eebw.
me or monyayee «cono-aa sener
T �P � � �
AEdress of rt�orcgagee or contract se�er (num6rleM stree; cdy, state, aM LP oode)
Name
Oces epplimnl rnm property in any oNer
counry in IMiana?
❑ ��
o�
Zo_ i �—
oi mortgage
y, slafe. end ZIP code)
rc res. wha� m�o�?
] No
COUNTY
zo_ � Zo_
�
numCer � Page number
unpaid as
Yes L� No
spouse. iMicate vrith whom
property in quesUOn: Mnualty Assessed
�IP�Opefty ❑/Vmuaily0.ssessed
n�ae H«„� nc s�.
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ia+5���
.C.�--. r.�.
m propnity
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I/ We ceNfy under the penatty of perjury Nat ihe above and foregoing infortnalion is true and correct and that the applirant is a resident of IrWiana a�
owner! contraa buyer of ihe aforementioned properry on date appliralion is filed.
Addmss of autho�'seO person
a�ootle)f� �^` `�
'�b
a�e� ornv� «oy �c
�4 my. s+ate, andLPCOde)
oate (monrn. ear. ree�