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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
�'`:4�`� State Form 93709(R71/6-09)
Presrn'bed by Department of Local Government Finance q�]
INSTRUCTIONS: _ !7
To be Red 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. F du Coynp3p ,r
2) Mobile/Manufactured Homes not assessed as Real Pmperty'Must Re during the twelve(12)months r`f
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional insiructlons and qualifications. GIBSON
Applicant owner buyer-see - on•we side) COUNT),�i141 I g/:. i#_a AVO/TOR
/- d- • . / Rena..number'/' P...e
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract lode ess unpaid as of Is the app it the sole
Maras 1:current year
March 1,atrteM year date of apPGnton ,/,(,\ legal ar equitable wnrell
/ TA) ❑ 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 different than that of apptcant,indicate below: Is tl(e property in question:Annuafly Assessed
�J5 Real Property ❑Annually Assessed
S� 1R:i �tt Mobile Home(IC 6r1.1-7)
Name of mortgagee or contract seller '� ^J'�('//LL,
Address of mortgagee or contract seller(number and street,city slate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number andsnsef,city,site,and ZIP code) �� / n/ $L do -07- 9 .•9//7&
Does applicant own property in any other If yes,what county? t -/What Taxing District? Has this deduction been requested on property
aunty in Indana? ❑ No for current year? ❑ Yes
❑ yes ❑ No
COUNTY AUDITOR - — I
Deduction approved in the amount of: - rx -
20 20 _ 20 20 Il.^r,+rr.,+�„r'f_C)
S
Signature of Canty Auditor - County
ILi— u5 _
I I We certify under the penalty of perjury that the above and foregoing information is true
I\ owner I niract uyer of the aforementioned property on date application is filed.
Y Signal o me) - Date(month,day,year)
I
Full resident address of applicant(number and t,orb',slate,and ZIP code)
'2270 S0..Yf 650 'cc - Frx 4orco r,J 1-i76r/4
Person authorized by duly executed Power of Attorney Or by IC 6-11-12-0.7 Date(month,day,year)
Address of authorized prison (number and street,dry,state,and ZIP code)