Mortgage_White (7)^^� STATEMENT OF MORTGAGE OR CONTRACT INI
,__ • FOR DEDUCTION FROM ASSESSED VALUATIC
� State Fam 43709IR71 /609)
�' ,,,, Presaibed Cy OeC��M of Local Govemment Fuarce
wsraucnoNS:
To be filed in person w 6y mail wiN the CountyAUditor or Counry Recorder of the co
Filrrg Dates: 1J Real Pmperty: Must fila dunrg fhe year (w which the deduc6on is
2) Mo6ile / Manufactured Homes not assessed as Real Pruperty: Mus
6e/ore March 31 0! each year the deduclion rs sought.
See reverse side for addjtic�al insVUCtions and qual'dications. _
MarUi 1. tlarent
If no, what's his
If name on tec�
rllegald�y�
o�
���
M2m,h 1. p
uWeate belovr
Year
MAR 5� 2013 File Mark
unry where the pmperty is 1 cat F� �� �:
soughL • CountyAUditnr
t fiie duri� onths
GIBSON COUNT`! %�UDITOR CounryRecorder
Remrd num
1 3 D -�do -C�p .9�-c�{ � �
indehtednrss unpaid az W Mongage / ContrxY inde6teM�s �mGaid as d
r+amemmorceagee«m,vaasener 1/V �i) /�,r�^^^/�C lit//
�%�� Z r / C.(
Address of mortgagee w contract seAer (num6e� and stree; cdy, state, arW LP code)
Name o� assignee w otlrer ovmer or halder ot mwigage
ACCress of assig�ree (number aM slreeL my. sfan
Dces appli�nt ovm properry in any oNu
camh in �mana� ❑ ves
De�utlion app�oveE In Ne
— .�1"�14'CP 1�r�. �`!I,�..l........
N c���a ���o. . �133
....................
- �, , ��-? �
ves u No
is Cie P��Pe+b in questim: MnuaOY Assesud
❑ Rea� Properry ❑ amuanynssessed
Moa� r� nc ��.
Has Ihis deductian Deen reCUested m P�Y
m� d,�,c y�n n.,_ _ r�
20 20 20 20 20 20 20
Sigriature N Counry Autlimr Counry Date (monN. day, yea�
I I We cerlify unAer Ne penalty of perjury that the above anC foregoing infortnaliwi is We and wrtec[ and ihat the applit�nt is a resident of Indiana aM
owner I wntraa buyer of the atoremerrtioned properry on date applicalion is filed.
SgnaLre /s hA repb) Data (monfi. deY• l'ae�
Futl 1fuQraM te L �\` 1///{� J 1���
�� � �
autMrized Dy EW1' exenrted Power of Y w by IC &7. -12-0.7 Oate (monlh. tlaY. Y��
Pddress of authar'ved person (num6er aM ; tlry; state, and LP oode) . ��
1