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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
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�' % Presaibed ey Departmem of Local Govemmem Fuarxe
INSTRUCTIONS: '^
To 6e ned in person or by mail with (he CounryAuditw or Counry Recortier o/ the county where the poperty is locat¢�"� N i ��
FrNrg Dates: 1J Real Property Must file dunrn,7 the year (or which fha deduction is sought � Counry Auditw
2) Mo6de /Manulactured Homes not assessed as Real Property Must file dunng the nveNe (72) mo�ithQ.
befora March 31 of each year the deduction is sayht Counry Recorder
See reverse side loradditional instnnMions andqualifications� GIBSON Cnuu�.. ..._
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; 1, anmt Ymr
I{!p, Wh3t IS hi5 / IC! BYdC Sh2f8 Of VIiPlESI?
It rwna on 2md's 61f�t than Nat W aDpl
a\ m revelse stl �
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r/ Mgal desaiDtion Remrtl numbrJ
- 9- 8 -3oi _ 000.a�8-o�� ao�
MortpaBe / Contract iMe6teOness unPaid as W Mongage I Cantraa utlebteEnnss �mpaid as d
Mamh 1, airtem year Eate o( ep�otan
D
tl owned with sameana oNer Man sPO�se. Gdkate with who
Nartre of nkvtgagea «mntracl seller //
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Mdress of nwrtga9rP or wntrad seller (num6are sb
Name M assignee or oMer owner w holdu of morigage
PilEress o ea (number antl atreef, �y. sfafe. end
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�OCS 8Q�C2_M OMTI p10pEf�' Y1811`f Of�ICf
caunry in Indana? ❑ YE5 �
DeducCOn apprased'v� �tre amwnt of.
20 _ 20
sy�an,re ar co�mry a,artor�
i�.T.
i/ We certify under the penalry of p
owner I contraci buyer of Ne aforer�
No
ciry, state. aM ZIP code)
�� �-3- ,5
s. w„a� mu�t�? VJha, Taorg DisNCt�
COUNTYAUDROR
20 _
that Ne
smte. and
20_ � 20_`_
rW foregoing mfortnatlon is We and a
date application is fileA.
(numbera�N 5CBe4 �Y. sbfe, an0 ZIP rode)
Page numOer
i3?
Y� u r+o
Ls Ihe property in question: Mnua�y Assessed
❑ Real ProPenY ❑ ��Y �
Mobile Flpne (IC 61.
H25 �116 dGdlKYltll b¢CII2QUPSt¢d Ofl pfOPPltY
for wrtent yeaR ❑ Yes ❑ �
20
aa1 I - I 3�l
: I Oa�° (rtaNh. 0a1: Y��
20
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