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,... .q, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION 1 / �22
�� ` State Form 43709(R14/1-20) [Jw,Sp✓1 2_(.
', Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. rrn filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Recorder
located on or before January 5 of the calendar year in which
Applicant(owner or c ttractt buyer-see stric ons on reverse side)
L1g,vps �V f'd i -m�. 'SOY
Taxing District /' Key number legal description Record number Pamper
O2 '_ 26-1 -13-�,1O1,k —000. B 4 6— D 24 24?2
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mort age/Contract indebtedness unpaid as of Is theoappllicant the
e sole
assessment date,current year assessment date,current year date application
y O �j er?
e, eg q/�y�
I es ❑No
If no,what is his/her exact share of interest? If owned wit someone other than spouse,indicate with whom
h property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Nam mortgagee orcontract seller
Addressip
o or contract seller(number and street,c //'�j
Drawer NO....Q�.11 ....
Name of assignee or other owner or holder of mortgage� ray'
Address of assignee(number and street,city,state,.nq ZI C 2•4 -"
Does applicant wn roperty in any If yes,what county?■l L`vvvv'•natt lazing uismct r Ion property for
esrIun en1 °quested If yes,state amount of deduction
other county ❑No currentpr year? es El No
a ua
in Indiana? JUN 2 a
A person is not it/ed to this deduction unless the person h s a a ante on the person's mortgage or out ct indebtedness that is recorded in the county
recorder's offi (i luding any home equity line of credit that is recorded in the county recorder's office)tha is the basis for the deduction.
may]_` 6C eZPL.419.790TY AUDITOR
Deduction approved in the amount of: GIBSON COUNTY AUDITOR
20 20 20 20 20 20 20
', County Date(rpon day, ar)
Signature of County ditor r _ , \c V,/') . tint,r7 Q �L�ZZ
Mfy�� i nS `�J J G.O
1/We certify under the penalty of perjury that the above and foregoing information is trued correct and that the applicant is resid nt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
ly,da
Signa r owners ull name Date gori!!//�� C .
Full�res�idern� ddre�,a�pppplicant(numberet,city,state,and ZIP code)
/i4L.J-) -S \6Nh lch _o• ` Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person (number and street,city,state,and ZIP code)
_. ... _ __-......,.--,,,.,,,,.ic imnricnnmant nn In two and a half years and a fine not to ayneeri.Ain nnn