Mortgage_Moore"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
.'. • Stata Fortn 93709 (R11/6-09)
`,w t Presaibtd M�M of Lotal Govertment Ffarxa
��
INSTRUCTIONS: � APR
To 6e Red in F� fl� �:
person or by mad witlr the CountyAWitor or Counry Recader o! the counry where the property is kcated.
Filirg Dates: 1) Real Property: Musf file durirg fhe year /or which the deduction is soughf. C��• unry Auditor
2) Mobile / Manufactured Homes rrot essessed as Real Property: Must file dunng the hvelve (12) monNs nty Recorder
before March 31 of each year the deduGion is sought.
GIBSON C
See reversp side fa additional inshuctnons arM qualificafions. _
�AOOGra➢� rwcon(rarl6vYES-seeresfillionsmrewrseside) . � . �
JL!/ ��F' i.� . /rw� _—
Ta�dng Distriti Key rwmha / legal desaiPtion O � DD Page wm0� �
a -�7 -r - �.03-00o SGo9 - � �- �
A�ed ralue dmal P�Y as d Mwt9age / Contraa IMeOted�ss un0aid az ot Mortgage / ContraU indebtednass �mVaid as d Is tlre eGP�t ihe sole
Me�U 7. prmG Y� Marrh 7, a�rtent yrar Eate d ePP��^ � w W���ae ownM
y ,� QQQ ❑ Yes ❑ No
tl �w, what is his I her exact share ot interest? H owned wiN somearre dher ihan spa�ae, iMimte wifh whom
It rerne m rwad'¢ dillerent tlun tl�at M aPP��+t'oi0ifate 6ebw. Is V�e ObPeM in OuesOOn: MuwaAY Assessed
�Real PtoP�rA' ❑ M�!�al�/ Assessed . . _
Name af rtnrtga9� a contrari
AOdress W mort9a9ee w mntrz
��
aeaa�
�ep�
munty m
DeducGa
�
state,
ov.,,er or hddu of mongaye
�erandstree4mY:slete, LPcatle)
� /
ry in any oNer If yes, at munt)?
❑ Yes ❑ No
amwnt ot
20 20
L . � . . r—v. ,
I I We cer6fy unCer Ne penalry
owner / contract buyer of Ne a
Sipret e (ownerS /u0 reme)
/ �.
C
Fu0 resi0ent eAOress oi appCran�(1 r
306 . S - Y�,
Person auNOraed Dy Euty exeprsd P
nddress d auU�a'ved ce� InurME
m�R� Kt�'�
SAa�qy
VJha� Ta�drg D'6tritl'
COUNTY AUDITOR
20_ 2p_
Caunry
ao��-ayaa
20 I 20
that the ab(lv�and foregoing in(ormalion is W e and correct and Nat ihe applirant is a resident o( Indiana arM
ned properi��on date application Ls filed.
Date (monfi. daY.Y��
�D w evt v P�� �/(/ `-t 7 h��
sfate. enC
Oate (mwiN, EaY.Yea�