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n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS un 7ownshi Year
_ • FOR DEDUCTION FROM ASSESSED VALUATION�-� ��
� Sfate Form 93709 (R71 / 6-09) �"�
�' � PresaiDeC by �epartmeM af Loral GovemrtreM Fuance JL
File Mark
wsrnucnoNS: N�V 17 201
To be filed in person w 6 mail with the Coun Auditor or Coun RecoNer o/ the ooun where e ro F� �� �
Y b b N P Pe�Y is rocated.
Fiiirg Dates: i) Real Pmperty: Must file durirg the year fo� which the deduc6on is sought. c r� �yCounry Auditor
2) Mob�7e / Manufactured Homes rrot assessed as Real Property: Must fiie dunng (Ae twelve ) nths
before March 37 of each year ihe deduction is sought. ❑ Counry RecUrdu
Seereversesideloradtlitiony.ir�(nm.tionsandqualrfications. _ GIBSONCOUNTYAUDITOR
Y tral properly as
Y�
�.� •�
Name of �rortgagee or contraU seller
Addtess ot mMga9ce ar mntract
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_
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r
/
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��51�!!
(number aM streef, rdy, slale, end ZIP oode)
Rcarv own WoPertY in any other
Indgna?
❑ Yes
�
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20
I/ We ceNfy under Ne penalty df perjury that t¢e above arW fc
owner I contraq buyer of the aforemerrtioned property on date
4 33
,�b � �
WAa,Tav�g
�uNn auortoa
zo_
Caunry
stare, antl ZIP cotla)
�r 1n4'i'v..
auUroReO Ey dWy esewted Pvwer of Attomey w by IC 61.142-07
person (numDerantl s�eef, dry, state, andZlPCntle)
is filed.
r.�
�
thanspouse,
Page
or eQUilaHe owrcr!
❑ Yes ❑ No
Is tM property in Vuestion: Mnua�Y Avessed
� Real ProPeRY ❑ !����Y �
Dra�ver �0... a�• �•i .......
�I 3� �
Caid 1�i0 . .....................
� ioa,98a.`�'j.
_ .� _I _ oa�e aro�un. daY I,�,� --
is true and cortec[ and that the applinn[ is a resideM o( IrWiana and
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