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"`n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
��_ _: FOR DEDUCTION FROM ASSESSED VALUATION
. s������R,,,�� F I L E
�„„ 1 PresoibeE by Department oi Local Govemment F�nce
File Mark
INSTRUCTIONS:
To 6e filed in person w by mail with Ne CounryAuditor or Counry Recorder of the coun 2 the pro rty is located. Fwm med wiN:
Fifirg Dates: 1 J Real Properry: Must file during the year for which the deduction is so�,"'� 2 g p�j p � Counry Auditor
2) Mo6tie /Manufactured Hortres rrot assessed as Real Property: Must file dunng the twelve (12) months
6ePole March 31 of each year Ne deduction is sought. County Recorder
C .'J. �y
See 2verse side 7or adtlitional insfructions arM qual�cations. v C�
App4cant(owne�or buyer- ee ' s reverseside)
`� , �r„ � � „ GIBSON COUNTY AUDITOR
Avessedvahiedreal�aP�Y�9f �
Martl� 1. amail 7Tar \.)
rc�. �� � rus i n� �e sna� of ��sn
tt fwrie m �ecad is dfierent uun that of app0
Name ot mortga9ee or contraG sHler
descTJiptim -�` ^ Record numher Page nunmber
� 1�' �.=� oV -V °1- I '�.— I ��
�e / Contra ' l� I �id as o( Mongage / Contract'v�tle6tedness unpaid as of Is ihe aP�t Ne sde
�, airtent date o( appGCatbn legal w equitade owne�l
❑ Yes ❑ No
tl owned wiM someone otl�er Nan spouse. ifWicate with wtwm
e ceaw � u,e �ceny �� o�: a�,eoy aaessea
. ❑ Real ProPenY ❑ ���Y�
mntract seAer (num6ei and shee; ciry, ste.e, arM LP oode)
of assignee w otlrer owner or hdder ot mortgage
neefess or as9gnee (nu,nbe. ane streec
Dces applicant own yoperty in any aNer I It yes, what countyt I VJhet Ta�drg DisGiG?
counry in Indana? � Yes ❑ No
Dra�ver NO...aO� �;
C�rd No. ....y9�
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