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.•°•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
su�e F«m as�os (as r z-0�>
�� � Presa3etl hY Departmen� W Local Govemmenl Firiance .
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�NSrnucnoNS:
To be filed in person or by ma�7 with the CountyAuditor o7 the wunty where the property is Iocated. � Zp08
Fding Dates: 1J Real PropeAy: Dudn9 the 12 months belore June 77 0l the year lhe deduction is to be eReGive. 1 Q
2) Mobile Homes assessed under lC 6-7.7-7: Befween January 75 arrd March 2 of Ihe year fhe deduction is to be'�tive.
See 2verse side /or additional ins6uctions a� qualifications. �
Applicant (oy ��or trad buyei/� e re�"��'�'�sp� verse side) /f ° COUNTY AUD170R
//�... /l l r �/I" /� A i. �l n n l I/ i �/ A e'1�_) GIBSON
Ta�drg I cl Keynumber/l6galdes " n—
�/ 3 �D�. �-� �
Assassed ralue of real popefty as of March 1, aarent y�r Morigage / ConUaa iMebtadness unpaid as of March 1.
wrteni year
If�Mai is his / her exacl share of interest? �f owned wiUi sortieone oU
If name m recad is d'rfFerent Nan Ihal oi applicant, iMipte belaw:
Name af morlgagee or canUaU seller
Address of rtaM1gagee u mnUad selter (number 0 es�, aty. slafe. arM LPcode)
Name of assigirea d dher oaner d hdder of mntgage
Atldress of assgnee (number a�M sLeet, city, sfate, aM ZIP coc
Does aPpiicanl own poperty in arry other If yes, M
county m Indiana?
❑Yes ❑No
�
approved in Ihe amount of:
20 � 20
a po� ��S/L
�k- D
V\ •
20 _ 20
CWnry
Is Ihe app6mnt Ihe sole legal w equitaWa wme(7
❑Yes ❑ No
spouse, indcate with whom.
Is U�e propeM in 9�tim:
❑ Real Procertv ❑ Moble Home QC G7.
3s Ihis dedudion been requestad on property
- wrzent yeaR
❑ Yes ❑ No
20
20
I/ We cerGfy under the penally of perjury that fhe above and foregoing in(ortna6on is We and corred and that the applinnts was I were a resident of
Indiana and owner of the afwemenfioned property on March 1, 20
ivaurn (numalc hdl rumef ,. Date (mmth. daY. Y��
_.adeM address of appliran/l J(n
�O� �LUQ//OGI�F-/!
Pasun au�Mr¢ed by duly e�ceculed
Pddress of aulhoi¢ed pn�sm (nwn
andslreeL aty.
61.142-.07
sGee.L r9y, sfate. arM LP wde)
v9G
oate (rranth. ear. r��)