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s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
CFOR DEDUCTION FROM ASSESSED VALUATION F I I Slate Form 43709(R11/6-09) I
Prescribed by Department of Local Government Finance
File Mark
To INSTRUCTIONS:ed in person rt'trec ,z n .
y Form filed with:
To be filed in perm or by mail with the County Auditor or County Recorder of the county whe teal.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought E. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during twelve 12�� E.
before March 31 of each year the deduction is sought - JIL , ntY Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Apo/Kart(owner buyer- on revs )
0 t
Tani D� ist [ Key number/ description Record camber Page number
5 .4,-i7-/P- 0 -00v. r3 /-193 / 0 ' 398
Asessed value of real Mortgage/Contract indebtedness unpaid as of ortgage l Convect indebtedness unpaid as of Is the applicant the sole
Match 1:cruet year March 1,rent year date of aPplrcatnn legal or equitable owner?
/40, 19 / ❑ Yes ❑ No
If no,what is his/her end 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 the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Motile Hone(IC 6-l.1-7)
Name of mortgagee or contract seller 53
Address of mortgagee or contract seller(number and street c$5 state,and ZIP code) '�'f--y�-^�`�-'f1''' pap a,
Name of assignee or other owner or holder of mortgage /2r� U ° ��I —
Address of assignee(number and street,coy.state,end ZIP code) /l ea
Does applicant own property in any other If yes,what county? • What Tast V\\J N� 3Q86) —
county in Indiana?
ll 1 t
❑ Yes ❑ No _ lo
COUNTY AUDITOR
Deduction approved in One amount at
20 20 20 20 20 20 20
Signs d ty Auditor Counryi. iOIX/b Date(monh,day,year)
, �, -.�
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?contract buyer of the aforementioned property on date application is filed.
Sigre, •/owner's fun = • Date(month,day,year)
/ 1
s so sl at
3 asc4,
Person son w by duly executed Power of Mon ey or y by(ICn 2-0.7 a1 C Z` _I 6,(,,,S-
' .
Date(month,day,year)
Address of authorized person (number and street city:state,and ZIP code)