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^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS oun 7ownship Year
7__ � FOR DEDUCTION FROM ASSESSED VALUATION
n State Form C37091R11 / G09)
�' ,�,� ✓ Presoibed by Department of Loral Govemment F`unca
fNSTRUCT70NS: I
b be filed in person w b mail with the Coun Auditor or Coun Recorde� of [he coun where the SEP mP�dyviih:
Y �Y �Y ty p�operty is bcared. V IL
Fifirg Dates: 1) Real Property Must file durirg the year for which tha deduction is soughL � Coun Auditw
2) Mobde / Manu/actured Homes lrot assessed as Real Prtiperty: Must file durirg the hvefve (12) months�� ry
betore March 37 of each year the deducfion is swght County Reoordu
See revers�e loradditional instrucGOns and qualfiptrons. G�BSON COUNTy pi in,�_ _
popeny es m
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S� � �,ti
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ge/ Contract indebtedr�s unpaid as of
— 1, arrem year
If owne
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Btcount�t IWhatTa�dngDistri[i?
COUNTYAUDROR
_ 20 20 _
btedness unpaid as d Is Ne applimnt Ihe sde
iegal w equitade ovmM
�j�% . � ❑ Yes ❑ No
spouse, kMicate WN whom
�pfOpCfl� Ifl Q�IP34qf1: iV1I1�12� ilS^�SEQ
¢3� PfOpEfly � i1fIf1U211yAS5C55Cd . . .
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Has �his deduaion Eern re9uested m piopeny
fw artent yeaR ❑ Yes ❑ I
2� � 2�
ICounry I Date (month, eay, Yea�
�ve and (oregoing infortnalion is true and correct and that the appliqnt is a resident of IrMiana arW
y on date application is filed.
oa� (r�m. dar. rear�
�?i
Date (monN. daY. Y�A
Maresswm�.�,........."" . aMLPCOtle) .