Mortgage_Smith (3)�
'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fortn 93709 (R11 / 6-09)
� Presaibetl M DepartmeM o( Laal GovemmeN Fumnce
Fi rk
INSTRUC710NS:
b be filed in person a by mail with the Counry Auditor w Counry Recorde� of the wunry whe�e the property is located. F1��m-��7 '.
Fiting Dafes: 1J Real Property: Must file during the year for which the deduction is sought M AR i y� OCB�nry Auditor
2) Mo6Ae / Manufactured Homes not assessed as Real Prt�perty: Must file dunng the tweHe (12J months ❑
be%re Ma�ch 37 0/ each yeer the deduction is sought. Counry Recorder -
See reverse side Jor additional instructions end qualifications. �
d / I��n��b%�I � ����lr�.Jl �.iv .d n � . __ �LL � GIBSON COUNTY AUDITOR
Pape numbrl
' - ' U- VV /
A�sed vaNe d rnal piopelty as ot Mor�page I Conbaa We6tednrss unpaid as of Mortgaga I ContraY inCebtedness unpaN az ot Is Ne applkant the sNe
Marrh 1, amnt year Mart�h 7, airtem year data of appGtatan 7� kgal a eputtade uwneR
U�v ❑ Yes ❑ No
11 f10. Wh2I6 hL5l11P1 GYdd Sh2l8 O( Y11B1E5I7 H owned wiN samew�e other fhan sP�e. Indxete wilh whan
Itt name on 2md is Eirteient Ihan that d aPP��t 6�Eitate Eebw. Is Ihe poperty in 9u�lim: MnuaM Ass¢sed
❑ Real Property ❑ Armualy Assessed
Mobile Flame IC 61.1 �
Name W rtnrt9agee a oontracc seAer -
�
Addrea of nartgagee a cantract snder (nuMer ard L �Ry: smte. aM LP m0e)
Name of assignee w other owner rn hdder of rtprtgaga
fmss of zss:,p�ee (ru,rMar erd saeet �r. sm1e. arie z�P ome)
es eppli�anl wvn poperty in any aNer IF yes, whal
mry in Indana?
❑ Yes ❑ No
ducEm app�vyad in Ure amount of.
20 20 20
inaweWCamtyaiaimr �_
1 I we cenify urWer Ihe penatty of perjury that the abov
er I contraa buyer ot the aforementiw�ed pro rty
� , (ownershm"er,�el A �` = �
aWwr¢ed Dy dWy exewteE
Nas N¢ tleCUOim been reQUrsted m proprlty
for wrtent yeaR ❑ Ye5 ❑ No
COUNTYAUDROR
— ' ' ' — _!
q 0 20
Dra��'e1' NO...:700.(....... — —
�� �,�. �Y ,��
C � I' (� �� Q. . . . . � � �C'� . . . . . . . 3PWi�ant is a resident of Indiara and
oa�e (md,m. mr. wen ,
aM sneet �Y stare. a.., �.. ._..._,
L•7�
AOtlre� of autlior'¢ed persan (num0al aM sneet ciN. state. an0 LP mtle)
oate (monrh. aaY Y�A