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.++"^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
s�a F«m aa�os �Re i zo»
S.e�� 1 Rwaibed by Department W Lonl Govemment Finance
i
INSTRUCTIONS:
To 6e filed in person or by marl wrth the CountyAuditor of the county wheie the property is bcated.
Fding Dates: 1 J Real Property: Dunng the 72 months be(ae June if of the year the deducGon is to be eRec6ve. 4 R / .
2) Mobile Homes assessed under IC 67.7-7: Between January 15 arrd Maich 2 of the year the deduc6 �, io'be el/ecFi ell �
See 2verse sidqlo� addifional insWctions ard quali�cafions. �—»,
� � � I O��a�-, ��
� ira o n d�wer-seerastrictions � e) � N , GIBSON COUNTY AUDITOR I
!/
N^� I�� KeY � legal tlesatpibn
,,,� i}0 -i� � a -lol-
value at �eal popaty as of Mardi 1. ameN year Ma�qa ntract
inle2sl?
If rame m record is difterart Uun ihat of applican4 indinle below:
Name of r�prigagee or canifac� seller �
I
Address or mortgagce « mntrad seller (num6er aM sVeel. aty. sfafe.
Name of asvgnee or dhef owner w tw�der of mMgage
shee; dty, sfafe.
Does applicant own poperty in arry oUer
twnry in Indiana?
❑Yes ❑ No
Deduction
�ti
I/Wec
Indiana
wnt of:
20 Q
�
�'d ,�,
� aforen
rtq��y.,
1� j
yes,
20
�3 � 0 a� ..�..._.. b...� . �_a_...�__-(�v
unpaid as af March 7, �s Ihe a{pGCani Ihe sde legal n equilahle wme/t
� ❑ Yes ❑ Na
med wilh sorrieone a4her Ihan spause. indcate wi�h whom.
Is Ihe praperty in quesUon:
� n ❑Real Pmperty ❑ Mobile Home pC 61.1
N7�at Taxing
COUNTYAUDROR
�
20
ductim been requested on pro{�eM
Y��
❑Yes ❑No
20
20 _
- �� ^---- — Dafe tla , yeaq
�ZDO' x� a�l � o � � � -o$
� I�:1\1'C C� Q. ........ Y..... . and correG and iha[ the applinnts was / were a resident of
' . Date (�^ fh. a Y 1'��l
�11'(1 NO . ..................... ,S/z8�68
�� �/o�i� ���.�vo
Y��)
Address of aWhor¢ed person (num6er aM shee4 �NY. sfate, aiM ZIP oode)