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""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tov:iship �_ Year
,__ • FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R11 / 6-09) �
�' f Presoibed by Depariment ol Local GovemrtreM Finance
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STRUCTIONS:
To be fded in person w by mad vnth the CountyAuditor or County Rernrder ol the county whera fhe property is bcated- F� fl� �:
Fi7ing Dates: 1) Real Property Must file during Me year for which the deducLon is soughf. /�U G e� 12County Auditor
2) Mobde /Manufaduied Homes rrot assessed as Real Pmperty Must fiie during the hveNe (12) month3 �
6e(ore March 31 of each year the deducfion is sought. Gounry Recorder
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See reverse side (or additional instrucGons antl qualfications.
(ownermmntraabyvr-seeresbic8'onsmraverseside) � -
GIBSON COUNTY AUDITOR
T OisfiG Key number I �egal desaiption RecorO numbu Page numbel
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AR¢sed d real as d Mortgage/ Contract'uWe6ted�s unpaid az o( Mortgage I Contract inAebtetlness unpaid a d Is Ne epplksnt iha sole
MarM 7, qmnt year March t, artent yeur dale of epplication �, legal w epuitable awne(1
K fq. W�Idi 6 �115 ��IPJ
U �ame a, remd's a
: 3!^7
Name of �ee w mntrar� se0er ��`Q c
Addrns d morpJa9� w contratl se�er (number and streeG �Y. sta�. ard ZIP code)
name rn asvgnee w omer owner w �voer a� mw[gage
own
DeCUCfion appmved in �he amount of:
�
someonei
.N,at m��ry.� I wnat ra�dny oi
COUNTYAUDROR `
20 � 20 � 20 _ � 20
�renue W Co�mty Autlimr
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I/ We certfy under Ne penalry
owner I contract buyer of Ne a
Person aufMf¢eE by tluly Exewted Power o(Attorney
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] Yes ❑ No
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quesnm: Miu�aOy Assesse0
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Card NO. ....3y.`��
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20 � 20 _
ICounry I Uate (nnnfh. daY. Y��
arW foregoing infortnatlon is W e and oorreG arM that the apptinnt is a resideni of Indiana arM
n date app(xation is fileC.
Date (nmRi, daY. Y��)
state, aIM ZIP mCe}
person (numberand sfreel, tdy, sYd(e, eM LP oode)
Date (rrmnN.
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