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^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ; y�,
_ • FOR DEDUCTION FROM ASSESSED VALUATION
� srate � a3�oe (aii i �os>
�' � PresmDetl M DeO��nt af Lawl Gavemment Firwce
File Mark
wsrnucnoNS: JAN 1 '
To be Aed in person or by mad with the CowtyAWitw or Counry Recader of the county where the property is bcated. � ��'
Fding Dates: 1) Real Property: Must file durrrg the year (or which the deducUon is sought fl q�i��
2) MobRe /Manufadured Homes rrot assessed as Real Pmperly Must h7e dunng the t:velve (12) mo ry
6efwe March 31 0l each year the deduction is sotx�ht - �/�i Caunty Recorder
Seereverseside7oraddrtionalinstructionsandqualifications. GIBSON COU
MP�^�� �� buy�- see resh!C�ns orl(e�rse s+de)
iu�mm n.�n /V � on�
v�r �
If ro, what Is Ns / Mr e�G share of inte�t?
tt rianie an remrd is drt(uent tlw� Ihat o( aPP��l'uMkate below.
Name of mortB,�aBee% r contrxt seller///7
\�C Olt/1/i / ✓irV( �
Address M mort9a9ce w rmtraq seAer (number and stree; riq: sbte,
Name af assignee or oNer awner w twlder of mwtgage
Atltlress ol assignce (number aM stree4 �+ry. slate, aM
unpaid as of
Il�ant rnvn pmperty in any oNer I If yw, wha[ munry7 I What Tari
Intliana?
❑ Yes n No
Yes LI No
someofre attwl ihan sV�. trdimte with xfiom
Is ihe praperry in puesCOn: MnueM�s��
� Real Pfoperty � AMUaliy Assessed
�0.... �' �. ' .
DI-a�vct' 1
5�� ........
Card �i ' `�N lS�
� '_".,...y
❑ Yrs ❑ No