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'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
- FOR DEDUCTION FROM ASSESSED VALUATION
s�ia F«m as�os �Ra i zv»
S r presmbed by Departmenl d Local Govemment Firance
rNSrnucnoNS:
To be filed in person or by mad wdh Me CountyAuditor o/ the county whera the property is bcated. � U N 2 2�� 8
Fd'org Dates: 1) Real Pmperty Dunng fhe 72 months be/ore June 11 d the year the deduction is to be effec6ve.
2) Mobile Homes assessed under IC 6-7.1-7: Befween January 15 and Maich 2 0l fhe year the deducGon is to be eliective.
See reverse side (or addi6onal insWc6ons and qualifications. `� � �
n � �i��°�
qpqican erorcony4�ibuyei-se mreverseside ' � � GIBSON COUNTY AUDITOR
T Irid Kry number / Ieg. des '
�
Asseessed rdue of real popaty as of March 1. aarent yeer Mor�qa�
aR�,
�hat is his / her esacl share of interesl?
If reme m recor0 is difFeren� Ihan �hal of applicanl, indiple below:
Name ot mort9a9ee or caniraG seller /J —�
Je
��..
Address of mort9agee a mnbaC seller (n�unber arH street. dty. sta
Name af assignee or aU� owner or hdder of martgage
Address of assigriee (num6er arM sLeet tity. slate, aM ZIP oode)
Daes applicanl mm property in erry oUer If yes, what
counry in Indana?
❑Yes ❑No
Deduction apprwed in Ihe amaun� of:
20
SignaWre of Couriry
20
_�i1��
7�j�- �O.�J7/-�G�o
% Contraa irWebtedrress unpaid as of March 1
��; . G� . ga
If ownetl wM sammne a
20
I/ We certify under the penaity of perjury ihat Ne above and foregoing inta
Indiana and owner of fhe afwementioned property on March 1, 20
�r�a4ue (owne/s / Ai) �i. / /. / �
cify, sfale.
executed Pv«er of Attaney « by
Address of aN7ar¢ed person (number arM s4eef, dty. slate, arM Z(P mde)
Is �he appficant Ihe sde legal w equitable owner
❑Yes ❑No
spouse, i�cate wilh whom.
(� ��6c� i , I��E'1� i �
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ry
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and corteU and that the appGranfs was / were a resident of
(monN. OaY. 3'��)