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" a°^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n 7 Year
FOR DEDUCTION FROM ASSESSED VALUATION
swe F«m aa�os �e i z-0»
�6 ,�» � pasrnbed by Deparlment W Laal Govemment Finance
t e
INSTRUCTIONS:
To 6e hled in person or by mad wdh the CouidyAUd"rtor o7 the county where the properfy is bcated.
Fd'o'g Dates: i) Real Property.' During the 12 months belore June 11 d the year the deduction is to be eHective. a�
2) Mobile Harres essessed under fC Gf. f-7: Behveen January 15 and March 2 of the year the deducfion is fo be e$Ectiv�e�
See reverse side /or additional instrvc6ons and qualifications. GIBSON COUNTY AUOITOR
�F`qme
(amei ar cvntrarl
ar�reverse
�� I a�- �d -io,3 -ooa. 88 Y- v a 8
rea� �y as or ��m i. a,rem yeA� Martgage I ConUad vde6tedness unpaid as of March 1,
ainer� rear i _ n -,
is his I her
mortgagee or canUact seller
f•"G:!'A
nddress or monpagee «mntraa sdler (numaef eno sfreet dry. sare.
Name of astignae or dher uvrrer w trolder
Address af
aM ZIP code)
R IP��
�„.35�
�s �,a ��,� � �a ��� a
wiUi mrtreone aher Uan spouse,
❑Yes �No
IS �IB PfOPBI�' Ifl GUBS�OfI:
❑ Real FmpeAY ❑ Mo6ile Home (IC 61.
Does appllcaM own poperty in arry dher If yes. whffi countyl What Tadng DRUicI� 11as tlds dadwlion bcen requested on poperty
cowrty in Indana7 f�' a'T� Y�n
❑Yes ❑ No . .� _ ...❑v ��❑.No