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_� STATEMENT OF MORTGAGE OR CONTRACT INDEBTE�SS Coun Township vear
; FOR DEDUCTION FROM ASSESSED VALUATION g
srata r� a3�o9 (Ri � i sw) l
,,,, j PrnsaiGetl by Deparlmerd o/ Loral GovemmeM Finance
File Mark
STRUCTIONS: NO V j (� ,n,, Form t�ed witiv
�o be filed in person or by mail wiM the CounryAUditor or Counry Recorder o/ tAe counry where tAe propert}� i31o�a1�
Fding Dates: 1) Real Property Must fJe durirg fhe year (or which the deduction is soughG C. �Counry AuEiwr
2) Mo6i1e /ManulaGUmd Homes not assessed as Real Pmperty Must file dunrg the twe �5 � �unry Recorder
before March 31 o/each year the Ceduction is sought GIgSON C
See reverse side (w additional instructions arM qualifications. OUNTY
App&ant(owrieroroontraU r- �friUionsmre�erse e „ '
Assessed rah�e ctm�l PoD�Y as o( I lAOrtpage / Can
'Mardi 7. qrm1Y year Mar� 1. qlrte�
.�
I( rw. what R his I her exact share af interest'!
I( rame on remrd'a Qfturnt lhan that o/ appficant, 4Micate belo�r.
t+ame of rnorrqaqee « mncau seue.
— /Y�E� rd
Do-
�
�
Deductior
N1_
3+9(aWre
�ct uUer (numbar ark
i/"�(t"
AL�NS�
/ I " Scx� S
�
I I We certify under the penal
owner I contraa buyer of Ne
I�?�(A��h�name) n
20
�
as o(
-3 0 0 �-t�oo. bS�?
��
kgal w equBade owne(t
❑ Yes ❑ No
If avmed with someorre otlxr tt�an spouse, indirate wiM wlmm
3
ZlPcode)
Cdi7�gf�"IrlIL1YL�7:1
20 _ � 20
Is C�e propnrty in puestion: MnuaDy Assessed
❑ Rea� Roperty ❑ a,rn,a�y r�ssessee
y�r.
20
� P�W�Y
❑ No
2(1 _
Launb Date (moNh. dfi: }'��/lT / /
�
of perjury t the above aM f ing infwmation is W e and cortect ar�d that Me applirant is a resident of Irdiana antl
orementioned property on dat pplicalion is filed.
Date (monfh. daY• Y��
Power of Attm�ey
Pdtl�s of a�nha¢ed person (numDera�d sbee4 Wy. sYdte,