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.,+°'* STAIEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
~ _ FOR DEDUCTION FROM ASSESSED VALUATION
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` s�e Fa,�, as�os �Fta i 2u��
�� 1 Prescribed by Departmenl of Local Govemmenl Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mad with the CountyAudito� o/ the county wheie the properfy is bcated. � U L � 9 Z �� 8
Fdiny Oates: 7) Real Pmperty.' Dunng lhe 72 months befae June 11 0/ the year the deduction is to be eflec6ve.
2J Mobile Homes assessed under IC 64_ 1-7: Behveen January 75 and MarcA 2 of the year the deduet/qqa�s to be�$�ctive.
See reverse side lor addifional insWctions and qualifications. ���a�� ���j
�'trad p er � 2sb¢GO98 m� �
/%� tilli
ricl . Key number / legal desc+iptio/ � Remrd number Page mimber
z.c.��-- vl 6-/� -!�3 - DD - I�/ �> d- Oa.S �n S 338.3
alue of real popefty as a( Mard� 1, ameM }�r Ma�gage ! ConiraG uitleWedness unpaiA as M Match 1, Is Ihe appG2n1 Qre sde legal ar equitade oxmen
airrenl yeat
%,- SO� ❑Yes ❑ No
is his I her erzad share of interesl? If awried wiUi mmeane ather Ihan spcwse, indicala with whom.
recwd is dMerenl �han U�al M applicanL indiole belovr. Is Ihe property in questirn:
❑ Real P`Operty ❑ Mobile Hare QC 61.1
morigagee orcontraU seller
of mo�igagee a cmtrad selier
Name of assigriee or dher awner or
Address
caunry
0
own property in any oUer
a?
❑Yes ❑No
wed in ihe amount of:
— I "'
9reet tlry, state,
dty, sfate. aM ZIP wde)
It yes, whffi
�
v,-�,,.��� .io�ao.�-���
Whal Ten � �. 'KY
C:l�l'(� 1�. , . ...... �No
................ —
,�oROF s�3 �jty � �' 7a, �c�.o, _
2p I 20 I 20
Dale (mmN, day, yea�
20
I/ We certity under ihe penalty of perjury ihat the above and foregoing in(ortnation is true and correcY and Ihal the applicanis was ! were a resident of
Indiana and owner of the aforementirned property on March 1, 20
�,u�� �m (numnrc hdl.��ma) ., i Dffie (mmth. daY Y�O
idenl addre�f ap licant (numbeiand strcel.
5 Gt%- �.50 S. F�,
auUmr¢ed bY duly ezewled Pwrer of Nlane�.
Atltlress of aultoraed pe+son (numbeiaM streel, aty. sfate, a�LP oo0e)