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"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
FOR DEDUCTION FROM ASSESSED VALUATION
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�� � Presrnbed by Deparlment of Local Govemmerrt Finance
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To be filed in person w by mad with Me CountyAudrtor o/ the courtty where the propeAy is located. MQY � Q Z �09
Fding Detes: 1) Real PropeAy.� Dunng the 72 months befae June 17 of fhe year the deduction is to be elfectiva.
2) Mobik Homes assessed urMer IC 6-7.1-7: BeMcen January 15 end March 2 of fhe year fhe deducfion is to be e8ective.
See raverse side lor additional instr�rctions arM qualifications. �,� ��
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nppN�cant(o�p, mrdredbuyer-seefpw�p�smreve�esde) � IBSON COUNTY AUDITOH
Ta�d i' Key number / legal d P�� RecoN num Page
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nss�d ��r m� � d n�a�d, i. arrem r� �se � co�waa �ndewed�ess u�v� as ot n�arcn i. is �,e apWcam u�e sde ie9si « ew��awa o.�n
°'��"�` 9 oQo
❑ Yes ❑ No
If a.cTal is his I her ezad share af irrterest? If awned wilh sort�eme ather Ihan spouse, �rale with whom.
If reme m recwd is tlif(erent ihan Uiat
Name af narigagea or
rtar�qagee or
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ri1y, sWte,
Ad�'� Dra�ticri\'O.c�C�
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Does [
couray h)
C81'v 1�'�. ...� lCaS
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�43,s�3a.�.......
COUNTY
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Sigrawre oi Caunry /Wd4or
p— � �— � p
Counb
Is ihe property in quasUm
❑ Real P�operty ❑ Mobde Home (IC 6-1.
a��'s.�„"'
11 Has lhis dedudian baen reques�ed on popertY
Lor aRenl yeaR
❑Yes ❑ No
20
20 _
Date (mmlh. EaY. yea�
20
I/ We certify under fhe penalry of perjury ihal ihe above and foregoing infomiation is true and correct and thal Ne appGcants was I were a resident oi
Indiana and owner of fhe afaementioned propeAy on March 1, 20
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Pason
aty. state, en0 ZIP oode)
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Pw.er of fLL�ntrey or by IC 61.1
of aWla¢ed person (�umbarand sheet rdy, state, aM LP oode)
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