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..�sr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
f,., � FOR DEDUCTION FROM ASSESSED VALUATION I L��
Stafe Farm 43709 (R8 / 2-07)
��' ;��• � Presa�bed by Departmenl of Local Govemment Firiance
wsrRUCnoNS: DEC 0 4F'���`
To be filed in person or by mad wAh the CountyAuditor o/ fhe county where fhe property is located. -
Filing Dafes: 7) Real Property: Dunng the 72 months be/ae June 11 o/the year the deduction is to be efleclive.
2) Mobile Homes assessed under IC G7.7-7: Behveen January 75 and March 2 of the year tl�e deducG�,�ohe,�9�.
See reverse side Ior additional insWctions a� quali(cations. G �
GI°SON COUMTY AUDITOR
Appl� m(owner w mnlract buy r see resMC4�pu qr reverse side)
C C/
Tabng Oistria Key number I legal desaipUon Record number Page number
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Assessed ue of 2al as d March 1, aarenl year Mortgage / Contraa intleWetlness unpaiE as af March 1, Is 1he appficant Ihe sde legal w equitade wmeR
arrent year / .
S� � q 10 ❑ Yes ❑ No
r'�. what is �is I her eamd share o/ iritemst? It owned with sortreane dher than spouse. i�cate with whom.
If �me rn record is differenl than Ihat of applicant, irWiote below:
mortgagee or cantract
rtartgagce or mnUact seller (number and siroet, tity, sfafa,
assig�ue a ather o.vner w hdder of martgage
Address of assignee (number and stree( city, sfafe.
Does applicaM am property in any oiher
counry in Indana?
❑Yes � No
Deduction approved in the amount of:
�
Signature of County Auditor
� I �
Whet Tacir
>uNrr auoROt<
�
Is ihe property in question:
❑ Real Property ❑ Mobile Home pC 61.
IYi
�rawer No.: 'ap -- ,�,�,
""'`-.-----� . -
Card No. .... � ❑ No
_ � �_._
-......._........... —
—^���QG.� —
za _ � zo
Date (mmfh. day, yea�
20 _
I! We certfy under the penalry of perjury Nat tlie above and foregoing infortnation is true and corred and ihat the applirants was / were a resident of
Indiana and ovmer oi the aforementirned property on March 1, 20 �
ua e( wne/s lull ne! l.. 1/t�''N � Date (monfh. tley, yea�
. v.��A, �o _ ��- �g
applicartl (num6e�tl�e1. crty
S / G
�ly execuletl Power of Ntomey or
Address of aulhor¢ed person
61.
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