Mortgage_Vaughn^'� STATEMENT OF MORTGAGE OR CONTRACT N Coun Township Year
__ _ s FOR DEDUCTION FROM ASSESSED VALUAT���
' Sfate Fartn 43709 (R71 / 609)
S,w � Preuribetl Gy Departmen� of Lnfal Govemmenl Friance
File Mark
wsrRUCnoNS: MAR 4 2013
Fwm Ned with:
To 6e filed in person or by mail with Me CounryAUdifo� or Counry Recorde� o/ the aounry where the property is located.
Filiig Dates: 1) Real Property: Must file dunng Ne year lor which tha deduclion is soug Counry Auditor
2) Mobife / Manufactured Homes not assessed as Real P�operty: Must fi � (12J months
6efore March 31 of eacA year Ne deduction is sought County Recorder
GIBSON COUNTY AUDITOR O
See reverse side 7or aQpiLOnal instructions arM qualificafions.
a�a �a,e orre� u�r � �
M2R�1 1, aam1Y yrv2r
.�b�- ia-i� `-40 �-aa�. 4�f9-oa8 ._� ��3
Mort�age/���nnn traa inde6tedness unpaid as U MMqage I Con7aG'vide6tedness unpaitl as d Is IA
March 1. ahqM yQar� O� date of ePP�m� �
/ V�
If ro, what Is his / her eraU share of interesY+
If rwrie an recdd is Eifrerent Nan ihat of aPP��l �7lcate �elm
Name of mxtgagee or cmtrari seqer
Addres of mortgagce or mnnacl se0er (mmber aM shee4 ciry.
Name of assignee or other axrwl ar twlder N mortgage
AEaress of assgnce
slate,
D i-a �ti er i\� 0....°.?'�� �
.........
Card i\'O. . 7�7
i�a,9�d.a3 .... ... . ..
1 I we certiry uneer the cenalty ot
owner ( contracl buyer of the afon
Person
If owne0 xriN someone other than spouse.
wna� ra,a�q o�ina?
couNrvauoROa
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Is ihe ProPP�Y in questic
� Real Properry ❑
Page
�itaWe o�meYl
Yes ❑ No
IAsseSSetl
Pssessed
ome (IC 61.
Has ihis deductim Deen requested m p(operty
for cuirent yea(.+ � Yes ❑ I
zo � zo _
r�d
the above and (oregoing intortnalion is We and correc[ and tha[ the applipnt is a resitlent of Indiana aM
property on date application is filed.
Date (month. daY. yae�)
dty, state, aM LP code)
7/V ��b�U
Date (monN. daY. Yaa�
�
person (number and stree; dry, stafa, aM LP mde) . 1�i
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