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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ _, FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn 93709 (R71 / 609)
S Presaibed by Department of Lacal Govemrtrent France
� Fiie Mark �
INSTRUCTIONS:
To be filed in person w by maii with [he CountyAUditor or Counry Recorder o/ the counry where the property is located. F� �
Fi7rrg Dates: 1) Real Pmperty: Must fi/e dunng the year (or which the deduction is soughG �� � �
2) Mo6de /Manulactured Hwnes rrot assessed as Real Property Must file during the IweNe (72J months
before March 31 of each year the deductron is sought ❑ County
See reverse side Ioradditional instruclions andqualifications. GIBSON COUNTY AUDITOR
MPdcant �arcontradbyrgr-saerestrirL'onsPn�versevtle) �% /�
wcscssed vdue d real no�nr as o�
Mard� 1, armlrt year
il ro. what ¢ h's 1 hr1 e�mG share of intrlesl?
It narrre on �ecoN is dMemrt Nan
or mntraG u4er
' J� "„
�e / Conbaa 4
. airtem year
�bw
Address of mort9a9ce or mntract se0er (num6rJend svce; city, staM,
Name oi assignee a other owner or hdder of mortgage
Atltlress of assignce (num6er aM sneet mY. state, and LP cotle)
PmPert1'
'v� tlre amount oF.
3_ood. 09��00
dnass unpaid as of Morigage / Contr
Aate of aoolkatio
It awnad w'rJ� someorre dher ihan
What
COUNTYAUDROR
20_ � 20_ � 20_ � 20_ '_�—. on
o �a o G a.�"
htedness unpaid as of Is Ne aPW��t Me sde
legal w equitable ovme(1
Q� ❑ Yes ❑ No
sPouse. rt�dicate wiN vRwrn
Is P�7enYinpuestion:MnuallyASSessetl
Real Property � MnuallyAsussed _
� �
Has Nis de7ur3iai Eeen
rw wnem r�R
� P�nY
20 _
�re���,��� �o� a
Drawer NO ...................
I/ We certify under the penalry ot perjury that the above and toregoing irt � ^� O, j ot Indiana aml
e I ntraa buyer of ineritimed property on date applicauoi t x� L�
� � r,m,�ma Card \O . ...........:......... �
�.. PW resident tlress of appfrcarc �l (number and sheet. � sbte, antl Z1P ootle) I��� l/�! "-"' �;� �
� � V Vh��`� l� �'✓l.� .i i
LN � -f'
Pswn autlia'¢ed Gy EWy ezecutetl Power o(AnomeY or by IC 61.7-12-0.7 Date (monf�. 0ay, yxa�
person (numberarW