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STATEMENT
DEDUCTION O MORTGAGE S ES OR CONTRACT INDEBTEDNESS fIpu Year
v4-! FOR DEDUCTION FROM ASSESSED VALUATION
f't• State Form 43709(R11/6-09)
C t"t�r Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: APR ` 5i,
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. • •• Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)mon j V r•Y/County Recorder
before March 31 of each year the deduction is sought. - tY
See reverse side for additional instructions and qualifications.
GIBSON CO • • • • r
Applicant nt wren of gont tart buyer-see re5p6-,lions on reve5 rse side)
Taxing District KKey/number/legal ddesai,ipptitionn Record number Page number
At- A&F - 14 -IS- 3o3 -0 o0. 9 / a -oa. 1.0 /3 iii
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
bS coca ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other the(spot indicate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
❑'Real Property ❑AnnuallyAssessed 1.1-7)
Name of mortgagee or contract sell ,
/l 7-A-cit-f--0
Address of mortgagee or contract seller(number i and street, state,and ZIP code) '
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP axle)
Wa.a aete 133 -- -_
Does applicant own property in any other If yes,what county? What Taxing C —� this deduction been requested on property
county in Indiana? ❑ Yes -n
❑ No �� M n Yes_ ❑ No
COUNTY AUDITOR
Deduction approved in the amount of. /3 —/ f/I / /8
20 20 20 20 I/ JUIJ
Signature of amry Auditor '• County
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signatu wn
re(oe = Date(month.day,year)
i
✓- l
�uII resident address of applicant(number and street,city,state,and ZIP code) �r
Person authorized by duty executed Power of Attorney or by I��1-1�7 rcet G ��, �� Date(month,day,year)
Address of authored person (number and street,city state,and ZIP code)