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.�f='� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CoLn "J Year
;, .,; FOR DEDUCTION FROM ASSESSED VALUATION
S�afe Farm 43709 (RB / 2�7) D E C 3 1 2008
°�; •� Presaibed by Department of Local Govemment Finance
INSTRUCTIONS: �6'� �F�a�
To be frled in person or by mad wdh the CountyAuditor o7 the courrty where the property is located. � � ��
Filing Dates: 7) Real Proper(y: Dunng the 72 months be/ore June il oJ the year fhe deduc6on is to be efFec6(�ptBSON COUP!TY AUDITOR
2J Mobile Homes assessed undei IC 6-7.1-7: Befween January 15 end Ma2h 2 o/the year the deduction is to be eNective.
See reverse side (oi additional instructions arM qualificafions.
(owner w mn(pd buyer - seepstncfions on reverse side)
Key number / legal d rnptan /
�16-a3-� -�nn�_oa/. O�v9-o �`%
of real popsty as af Martli 1, curtent year Mortgage / ConVad intlebtedness unp� id as M March 1.
arteM year � ^ /'� (� �
x ��' �
exad
Name ofm/q�rlga gee or coniracl seller
/ i � ; n _ .. i
Address ot mortga�e a mnuaa seller (number and street crly. uste,
Name af assignee w ofher oxrrer or hdtler af mMgage
property in any ather
❑Yes ❑ No
Deduction appioved in the
zo
Signature of Counry Autlilnr
If yas, whal counry? What T�
couNTVnuoRc
zo _ zo _
Is U�e
SomeMe aUter lhan spDUSe,
Reoortl number Page number
Q�i ��l � l
w equitaae owrier
❑Yes ❑ No
Is �he propeM in question:
❑ Reat Pmperty ❑ Mobile Home pC 61.
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i5
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Date (mon(h, day. yea�
I I We cerfify under the penalry of perjury that the above and foregoing information is We and mvecl and that Me appGcants was / were a resident of
Indiana and ovmer oi the aforementioned property on March 1, 20 _ �
wneYS lull neme)
ri�� .
address of applicant (ni
' -�G
vizetl bv tluW execulad
sfreet.
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Address of aulhor¢e0 person (num6ei aM sbeet cdy. sfale,
Cay,yea�