Mortgage_Harrell^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_,. � FOR DEDUCTION FROM ASSESSED VALUATION
, Sfate Fwm 43709 (Ril / 609)
�,�,� Presui0ed by Oepartmen� ot laal Govemrtrenl Fnance
INSTRUCTIONS:
To 6e filed in person w by mail wifh Ne CountyAUdito� or Counry Recorder of the county where the property is focated.
FiNig Dates: 1) Real Property: Must fife dunrg the year /or which the deduc�ion is sought n
2) MobAe / ManuFactumd Homes not assessed as Real P/operly.� Musf file dunng the hvefve (12) month� AR
6efora March 31 of each year Ne deduction is sought.
See reverse side lor adtlitional inslrucGOns arM qualfications.
Ap 1(ownei w contfaU b er- see sfnr,tions m reverse sidej
Year
�1�Counry Auditnr
IJ
County Recorder
` ��J GIBSON COUNTY AUDITOR
Taring isviri Key number / legal Cescnption Recortf number Page numbnl
a�- o- 3 - oo -�03 0_ o a. �o r3 53
A�sed value 2al ot Mor�qage/ ContraG UNehtetlness unpaid az of Mor�qage I ContraG ifWebtedness unpaid as d Is Ihe applirant the sde
Mamh 7, aarent March 1, wrtent yeer date of appLcanm � legal ar eQuitaWe wmrll
� � ❑ Yes ❑ NO
f no, what is h' her eYao sh of interest? If owned wiM someone other than sdasse, iMirate wtth whom
If name on recorA is diRerent lhan that ot app�ni. 6MUate 6ebvr. Is ihe P�operty in puestim: MnuaM Assesv.d
❑ Real ProPerA' ❑ A"^ua�Y A�ed . . _
Name ot rtartgagee or contraa seller
neeress or rronqagce «mrio-aa sen�
Name oi assignee w oNer owner or h
Piltlrass al asvance In�mber aM stn
Dces epplicant avm property in any olher
munry in Indiana?
❑ YCS
ffire,
rtprtgage
slate, antl ZIP cotle)
�
If yes, what munD/t
No
Fcu
6 Tsrg Distr�? Fias Nis tl�o�, Eeen �Q�es�ed m P�+�Y
fww�rerrtW�' r� .. r-�_,
COUNTYAUDROR �y'�I �
Driucuonappmved'u�iheamoun[of. �J ,,,.
Dra�cer NO ...............
20 _ zo _ zo zo 20 _
S .....
�
CardNO . ./........... ..
Sigre d Counb Auelwr ` Counry I�� IV--�—� � C�
I�/ We certify unAer Ne pe alry of perjury that ihe ahove aM foregoing information is we and correa arM that Ne applirant is a resident of IrWiana ard
owner I contracl buyer of the atorementioned property on date applintlon is filed.
Pelson authu'ved Dy EiAy ezew[etl Power d atomey
ldEress IN autha'ved person (numDeraM sbee4 �'.
s+ate,
slate, antl
c
(monlh. tlaY. Yea�
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