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'°3q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ � FOR DEDUCTION FROM ASSESSED VALUATION
' stam Form a37os (R71 � 6W)
,�' - f PresrnDed b�' Department of Lo�al Gavemment Rrerrce
�
WSTRUCTIONS: �
To be fi7ed in person w by mad witli the CountyAUddor or Counry Recorder of Ne county where the propeAy is bcated.
Fditg Dates: 1) Real Pmperly Must fife durirrg the yearlor which the deducfion is soughG c� 1'
2J MobDe / Manufadured Hanes rmt assessed as Real Pioperty: Mus7 file dunng the hvelve (f 2) moryuffg i
before March 31 01 each year the deducfion is snught.
See reverse side lor addiGOnal instructnons and qual�cations. /�� .
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rc�rt�e m n.ma a mnrlen[ w
Name ot mortgagee or contrarl
PEdtes M mort9a9¢E Of Wntra
r � ..
.D - 00 - G D D. ��- �
�. / Contract 4debiedness unpaid as of Mortgage 1 G
cumnt yeer date of appGc
rc ovmed wim mmeo�re
ihat of aPP��. uWipte Eebw:
sta�.
Name N assi�F�ee n aUrer ownu or hdder oi mortga9e
ALdmss ot as9gnce (nu+nber aM svee( 'cy; stete. � LP c�e) �
SE �
Ooes applitant own p`operty in any othu If yes, what countyt
munryinlndiana? ❑ Yes ❑ No
oeau�, awmuetl In Cre amwnl ef:
za _ zo _ zo
AUDROR
zo _
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Year
Counry Audimr
CounTy Ruader
GIBSON COUIJTY AUDITOR
Reco�d num0er Pa9e numbu
/ l a- G 6
2 trMe6ledness wpaid as af Is ihe appfinnt tha sole
legal a equitahle oxnerl
GUD ❑Y� ❑No
r than sPO�� md�te WiM whom
Is Me V�PeNY in OuesGOn: MnuaDyASSessM
� Real PfoPenY ❑ !vm!W JAsse°_�_ . . -
�;AM3
zo_ I!�'�.n3�ol
I/ We cenify under Ne penalty of perjury that the above and foregoing infomation is true and con
owner / mntracl buyer of Ne aforementioned propeRy on date appiicatlon is filed. '
Pasm auGwr¢e0 Oy dNy ezecu�ed Porer ol Attcmey w by IC 61.1-72�.7
Address of aNhor'ved pert.w� (number and sbeet �N. ��e, a� LP cotle)
7U
sted at P�Y
Yes ❑ I
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