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1' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
footeState Form 43709(R71/64)9) Q@��
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county wheistiti plisperficyl*cated. Form filed with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought `Q(, County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file du' the twelve(12)months l'^'
before March 31 of each year the deduction is sought - El County Recorder
See reverse side for additional instructions and qualifirr tions.
GIBSON COUNTY AUIIITCIR
Applicant(owner or.. •..-buyer-see re ili= "•e)
i 11 C r i
fl9?C" 1 Key number/ I desotption Reaae manner
ti o G.i �- 3o3 oar. 3a a t 07 Page number
value of real property as Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,anertt year \ March 1,cement yeah goo date of appli anon legal or equitae owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? tf owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Bane(1C 6-1.1-7)
Name of mortgagee or contract seller
"dt tfili 07L—alint"
Address of mortgagee or contract seller(number and set.city,state,and ZIP code) /
ae
Name of assignee or other owner or holder of mortgage
Address of assignee(number and steer,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property .
county in Indiana? El Yes ❑ No for current year? ❑ Yes ❑ No •
COUNTY AUDITOR
Deduction approved in the amount of
20 20 . 20 20 20 •� 20_ 20
I
Sig of ry Auditor' County i / 1 Date(rtonyrylpy 7394 /
I/We certify under the penalty of perjury that the above and foregoing information is a and correct and that the applicant is a apt-7394V
of Indiana and
Amer/contract buyer of the aforementioned property on date application is filed.
gdeFue ) Date(month.daY.Year)
ss of applicant(number and stee cry,state,and ZIP code)
5[ . Mo r-{-m-, A-. Oakta,fidCG Ill `f 76:6o
Person authorized by duly executed Power of Attorney or by IC 6-L1-12-0.7 Date(month,day,year)
Address of authorized person (number and street.city,state,and ZIP code)