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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�,; FOR DEDUCTION)FROM ASSESSED VALUATION
-tt i. State Form 43709(RU
presaibed by Department of Local Government Finance I
LieE,
INSTRUCTIONS: Willett
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. J U IV 1 O L U I y
Filing Dates: 1) Real Properly Must file 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 In,atunt9Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Apprrant ror.• %ct buyer-see restrictions op reverse side)
Ta Key number/legal des Record number Page number
, A6, - 1 07 - - 3o.3 - o0 a. 635 - 0 )-8 a.D (tf ,2o (90
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,oQrem year Mardi 1,°ment yrarg D O O date of application legal or equitable owner?
9 ❑ Yes ❑ No
If no,what is his/her exact share of interest? /.. If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate below Is the property in question:Annua!y Assessed
❑Real Property ❑Annually Assessed
. Mobile Flan(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(num e�4 cipt state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) 2 ��
ari a 1 ). Pr - -
Does applicant own property in any other If yes,what county? • What Taxing Dist --'-- on omperty .
county in Indiana? No
❑ Yes ❑ .DI a)rel- N
COUNTY AUDITOR •.. _
Deduction approved in the amount of: Ca 1-d No.
,,a0 Q -
20 20 20 20
ryrey (
Sg' na County Auditor County Date(mwim.w,..- .
/•ICIIII 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.
(owners(.re neme / J -� Date(north.day,year)
Full resident address of applicant(number and street,city, ttee,,aannd ZZIP code)
5« $, Hat 4T, Pr& ?ceMn,L,,,., 4-(9690
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and.street,city,state,and ZIP code)