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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
FOR DEDUCTION FROM ASSESSED VALUATION
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To be fiied in person a by mad wrth the CourttyAudrtor o/ the courrty where the pioperty is bcafed.
Fd'o,9 Dates: i) Real P�operty: During the 12 months be%re June if d the year the deduction is to be eBec6ve.
2) Mobile Hames assessed w�der IC 61.1-7: Betxeen January 15 end March 2 0l U,e year the deduction is t
See raverse side la addiLOnal instructions end qualifications.
_ GIBSON C0� AUDITOR
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Asssaed ralue of real prapeity as
see re �ms m re�erse gde> �// /`
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Key mber/legalde 'ption
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Match 1. a+re,LL Yav Martga9e / Corrtract inde6tedness
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her exaU share of iMeresl7
If reme m reard is d'A(ereN than that
Name of rtartgagee or conUacl seiler ^ A � �
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Addrass of moM1gagee «mntract seller (number anASL'eet dty. sfafe. an0 LP crode)
Narne of assgnee ar otlier awner a hdda d martgage
Address M assigrree (rusMe/ aM sUee4 tity, state. aM ZIP code) '
Does apqicaN own property in e�Y olher Ir yes, what courrt�l Whe�
courdy in Indaia7
❑Yes ❑No
Deduction apprwed in Ure amounl of.
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Sigrature
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1 I we certity under�(ie penalry of
Indiana and owner oi fhe aforems
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COUNTY AUDITOR
// . RewN yrw�mber Page ru/m-ber
�, � a V �P �
of March 1, Is the app6mnl ihe sde legal or equitahle owne(7
❑Yes ❑No
someone aher Ihan sPW se. indicate with whom.
20 20
Camh
Is Ihe property in questim:
❑ Rral Property ❑ Mobde Home
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20 _ � 20
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ihat the above and foregoing infortnation is W e and correct and that the appGCants was / were a residenl of
ProP�Y on March 1, 20 _
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Dale (mmth,