Mortgage_Armstrong'�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
� : FOR DEDUCTION FROM ASSESSED VALUATI� ��
:, Sfate Fam 43709 (R71 / 6-09)
�` ,u. � presoibed by Department af local Govemment Frianca
File Mark
lNSTRUCTIONS:
�[} 9 (j� Fam t�eE � '
To 6e filed in person or by mail viith the CountyAudita or Counry Recorder o� the county hhr�'thN��1ry� bcated. �
Fdirg Dafes: 7) Real Property: Must hle dunrg the year for which the deduction is sought County Auditor
2J Mo6De / ManuFacfured Homes not assessed as Real Property: Must fiIe d g the h He hs
belo,e Maroh 31 of each year the deduction is sought. ❑ Counry Recorder
Seereversesideforadditionali swctionsandqualifications. GIBSON COUNiYAUDITOR
App&ant (ownei bu�e fsre resvictlms sde) �,
Asessed vaWe aF real
M2idi 1, anent ymr
tt ro. whal �s his I her era�Y st�ara OI inteJesfl
Mortgage�/
rt�h 1
If nartre m recortl is diRerent Nan ihai a/ applirant,
R' • ! S .'r. .r. R �_ �-' '_ � 73
15-=2/
II
or cantrad sr�er (num6er eM svaef, cdy, state, aM LP code)
Name M assignee w oticer owner m holdu ot rtqrtgage
Addre55 of a55ignee (num0er eM Sheet, C% 51dte. end ZIP tode)
Does BPD�if2nt rnm praperty fn e�ry i
munryinl�W�ana? 1-1_..�
D1'�11'�1' 1�...^0.��........
Card NO. ' S5�% _
- .... . ��'$�;�. . �I
-OCb?, Da5-oa �
as Of MoM1gage / Contract i�Webtedness unp2zl a5 ot
date of appG�ation
x Page num6a
ia s
Is Ihe epprir�anl the sole
kgal w equitaWe bwneR
❑ Yes ❑ No
If awned wiM somearre aUrer ihan spouse. udirate with H1mm
COUNTYAUDROR
zo � 20
Caunry
Is Me property in quesUm: MnuaDy Assessed
❑ Real RoPertY ❑ Mnualy Assessed
m yeaa
20 _
requested m D�RY
❑ Yes ❑ No
Date (monN, daY• Y��
zo
under the penalty oi perjury Nat Ne above and foregoing infortnation is we and cortect arW Uiat Ne applicant is a resident of Indiana arM
act bu r of the afaementioned property on date appiication is filed.
5 (iA ) � Date (nrnth� daY Yma�)
Prl:m autha'¢Ed Dy EWy executed
Addre55 W auNaveG person
by IC 61.1-12-07
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