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^'na STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_,_ : FOR DEDUCTION FROM ASSESSED VALUATION
n Slata Fartn 43709 (R71 / 6-09)
•�' w�. ° presrnbee by Depanment a1 Lacal Govemment Fnaxe
'e a
INSTRUCTIONS:
To be filed in person w by mail with the CounryAudito� or County Recorder o! the oounty wheie the property islo�{qQ� Farm med wiw:
F�irg Dates: 1) Real Property: Must fJe during the year for which the deduction is mught IV U V 9 � �� �unry Auditor
2J Mo6Be / Manufactured Homes rrot assessed as Real P�operty: Must Ae during the fvreNe (72) months
befora March 31 of each year the deduction is sought C� Counry Reoorder
See reverse side /or addUonal instrucdons and qualifications.
Mprirant(ownerorm�ur�Cbuy�-see�tioasmreve+seside) � ^ I/,� . GIBSON COUNTY AUDITOR
�A J, 11��� nn .w� (�'pll�n�
ro,
�- - -- - _ a_ i � _o _. sa
Martgage/ Contrari indehtetlness unpai0 as of •Mwigage I Contract indebtedness unpai0 as o( Is ihe ePDO� we sole
MarM t. date of aPP�� legal or equitable owne(1
❑ Yes ❑ No
a rc ownea wim sm,eufre ouwl man sw�� �aicate wlm whom
If name on recad k drtfuent ihan Nat of aDP��. ��� �low:
rWrre m mortgagee
assignee w othe� owner or imider of rtavtgage
Atltlressofassi9nee(numberardstreeL�+q"-'-'- - G
Does appliCant wm property in any other
�iT�S, 1�1�-��"
munry in Indana? ❑ Y25 �
I a.' S�►S�
DaiucGan aoomued'ui Ihe amount aF.
20 I 20
I I We certify urWer the penalty of
owner I contracl buyer of ihe afw
(owne TWI
F �e� ��� t md
a� aw,o�aea ey awr �ewxa r�„
lddressofaWwraedpuson (numbera
Is ihe PtaPenY in Vues6on: Mnu.
❑ Real Propel(y ❑ Mnua
Modle
Has Nis deduction 6een requested m P�P�Y
for artem yeaR n.._ _ 1-1 �
20 _ � 20 _
that the above and foregoing intortnation is W e and mrtect arM that the applirant is a resident of Indiana aM
ned property on date application is filed. .
w Cy IC G7.7-12-0J
5laM,
_ __ __ _� o� (,�«,m. eer.
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,,�i FOR DEDUCTION)FROM ASSESSED VALUATION
State Fans 43709(RU I6-09
Prescribed by Department of Local Government Finance FI I a
INSTRUCTIONS: `,F e�,
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. MAY.' '. Lt
Filing Dates: 1) Real Property Must Me during the year for which the deduction is sought. 74 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought I sU14 • 'ecorder
See reverse side for additional instructions and qualifications. __GIBSON COUNTY AUDITOR
Appkiant(owner or contact buyer-see reverse side)
.Zorr efe othroo k.
Ta v,t,District Key lnumber/legal desorption -Record number Page number
rto n d j In-zo -o l - loo-ool -9 \a-co J /3 0? 5
Assessed value af real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,Durrett year March 1,amen y;err date of application legal a❑equitable owner?Yes 5
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.indicate below Is the property in question:Annually Assessed
plea]Property ❑AnnuallyAssessed
• T Mobile Home(IC 6-1.1-7)
Name of mortgagee or ^
�a r ma n /T NA Qr t ca 1't.
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
—-)
Name of assignee or other owner or holder of mortgage R �Q ffi
Address of assignee(number and sheet,city.state,and ZIP code)
Does applicant awn property in any other I If yes,what county? - I What Tarring Distil /3 - / !-�/ /
manly in Indiana? ❑ Yes ❑ No (//(`tJVVV
COUNTY AUDITOR 1 311 C/1U Le
Deduction approved In the amount aft 5 I J l/
i
20 20 20 20 20�
Gagman apacoel
Signature of County Auditor • County
I
I I We certify under the penalty of perjury that the above and foregoing information is true and d
owner I contract buyer of the aforementioned property on date application is filed.
S�(l[g/`naLr rY hdl rierrreS' �/J i _
✓•"W of appGgn/�(number and sirs reet ply,state,and ZIP code) -— - - ---
b /, 2(c- E. e, ( q 5. Ca,agst.../ 4) 4/�Ti. �17oi10
Person authorized by duty executed Power of Attorney or by IC b .1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city Stte,and ZIP code)