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e:) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION $
State Form 43709(Rtt/6-09) ;Prescribed by Department of Leal Government Finance I %
INSTRUCTIONS: a�
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is locaterA P R y .J
Filing Dates: 1) Real Property:Must tile during the year for which the deduction is sought. - County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought. L t�fi: • • Recorder
: ..idn
See reverse side for additional instructions and qualifications. GIBSON COI1N1Y
AUDITOR
•.. .... .rorcontract buyer ....restrictions on reverse side)
Key ' •- .0 •- desaip leco number Page nur6r
Assessed vatic of real property as of Mortgage/Contras indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the am:Scant the sole
March 1,anent year March 1,current year date of appfiyatior') ^i ❑ es ❑ old
C/{n C��( (,/_' Yes
11 no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below. Is property in question:Annually Assessed
RS Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contrail sager /l/L//') r
Address of mortgagee or contract seller(number and street city,state,a P code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state.and ZIP code) . /✓� n ^D eQ r7 �� `s
Does applicant own property in any other If yes. t county? What Taxing District?Pn"p// Has this uUion been requested on property
county in Indiana? ❑ Yes ❑ No for current year? ❑ No
❑ Yes
/
COUNTY AUDITOR .
Deduction approved in the amount of
•
20 20 20 20 20 20 20
Signature of County Auditor County —---__I Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true Via 1V.e 1, N O, - 10/
owner/contract buyer of the aforementioned property on date application is filed- ......,
'.•ature(owner's/sea name) 1582:2•••••••• �'
a Full resident add—x-a a.. (number and sheet,city,state,and ZIP code) ••••...., —
163y inP s1 01UCiZV. izs }-ry y-Sgt - . 1 -- •1e0$950 ... —
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 1
I
Address of authorized person (number and street.city,slate,and ZIP code)