Mortgage_Moskos^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 7 ship vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
. srace rwm a3�w (Ri i i s-oe�
S � p�y,n3¢d �y Oepartmenl af Lod Goremment Fnarxx
File Mark
iNSrnucnoNS: DEC�2 O
To be filed in person or by maif with the CowrtyAUditor or Counry RemNer o� the county whe�e the pioperty is locat ��� ��
Fifing Dates: i) Real Property: Must fi7e durirg the year (o� which the deducfion is sought r ^ � Counry Audhor
2) Mo6de / Manu/aclured Homes rrot assessed as Real Pluperty Must fiie during the fvmNe (72)T�TI s
6efore March 37 of each year the deduclion is soughG Counry Recorder
Seereverseside/oraddrtionalinshucfionsandqualificalrons. GIBSON COUNT
AuaGmnt {waer u contraC buvel,.see reshiUions m rerx[te silel
T' istri Key numher / Iegal desaiption
b-aa-��f-3oo-00l. S�s-o�
raWe aFinal ryoperty as ot Martgage/ Contrac[ 4dehtedn�x unpaid as of Mongage I Can:r.
7. aa'ent Y� March 1. wrrent Y� date of appOCatior
/
if ro, what Is his / her exarl sham ot infelesl? IF awned wi� mmeofre o i
tt name m remrE is dAturnt Nan ihat of aDP��L trW'uate Eelmr.
Name of rtnrt�a9ee or rvntrs<i se�ler . � . n
AEdress
Yate.
otlier owner or hddu of mortgage
of assignea (numDer arM stree4 �++JS s+a:e, and LP wde)
Dors aPpli�ant wm pmperty in any oNer I If yes. whac munry?
caunryinlnd'ana? I"1 „ I"I ..
20 _ 20 �
S'gnaN�eepf Caimb AudRor —
/'
l._
I/ W rtify u�er Ne penalry W ry Nat Ne,
own r I ntracl b of the aforementioned prd�
� Sqre (ovme/shm )
AUOROR
Remrtl numhrl
w
Yes L� No
i
Is the PraPPnY in Ouestim: Mnuelly Assessed
� Real PruPertY ❑ H!TM�!���Y�
/�osKOS, G�y �J
Q �- ,3�8 /
20 _ � 20 _ � 20 _
oate (more4 dey, yaafj
20 _
nd foregoing infortnalion is W e and correU and that the applinnt is a resident of Ir�ana aM
date aoMcation is filed.
auNarrseA Dy OWy executed Power of Attort�ey w by IC 61.7-t2�.7
ALtlresso/autha�tlpelson (numDerarMSbceL�'+�Y.sfata.