HomeMy WebLinkAboutMortgage_Besing (3).e�•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
r°,f... :'= FOR DEDUCTION FROM ASSESSED VALUATION ����
� State Farm 43709 (R8 / 2-07)
��i3u' �J ���� bY �Pa�enl of Local Govemmmi Finance
INSTRUCTIONS: �G�J� GaG 2��8
To be �led in person or by mail with fhe County Auditoi o/ fhe county wheie the property is located.
Fdinq Dates: 1) Real Property: Dunng the 12 months be/we June 71 0l [he year the deduction is to be elfec6ve.
2) Mobile Homes assessed under IC 64. 7-7: Behveen January 15 and March 2 of the year fhe deduc6rn is to be��ve.��
See 2verse side Iw addiFional instruUions arrcl qualifications.
GIBSON COUNT
Applirant (owner or mn4ad buyei - see restricfions on reversey� )
(l . 1 / �'�-t�1 1 1 � /\ � .\ . n � n
Tapng cl §ynumberllegaldes�iption
��.�cr� � � l,. :1p - b`i -
PssesseU value of 2al propertY as of M1larch 1. aarent year Mortgage I(
airtenl year
whal is his / hu pxaci share of iriteres�? ,
,
If reme on record is differenl U�an Uat of applicant, indicate below:
Name of mor�ga ee or canUxl selkr
Adtlress of moM1g e or conUacl seiler (num6e� aM sbeet, dty. state, arM ZIP co�e)
Name of assi9nee a other owner or holder of mongaga �
Address of asvgnee (lximbei arrd sUeet city. 9afe, aM ZIP code)
�oe5 applicant ovm property in any other �f yes, wha� oounty?
county in Indara? (�` �
❑Yes 'll�'No
cou►+Tr
DeducGon apprwed in the amount of:
�
Nitlilor
� I 20 I 2C1
���
az
Page number
Ihe appGpnt Ihe sole legal a equi�ade owneR
�hYeS ❑ No
with someone dher Ihan spouse.
property in question:
al Property ❑ MobBe Home
_'�Y
p � No
Drawer NO.�Q�2.:�?.��
� —
„� ard�N�O�,�,��i� Gf�.:.°..°. _
�/ _
yea�
I! We certify under the penalry of perjury that the above and fwegoing infortnation is We and correcl and tliat ihe appGpnis was / were a residenl of
Indiana and owner o( tlie aforementioned property on March 1, 20
�riaWr ne/slWlname) ' /ry� ,/�,� ,.—c/ Dale (rtmnfh, tlaY• Y��
I� �.(�L%/ 7/ � / �" )�i
�resitlenl�ddressotapplicarrt(ny�n6e�ands�ei.cdy. _te.aMZIPtroOe)
by
w
aWhoraedperson (numberarWstreeLafy.sfate,aMLPootle)
Date (rtanN. day yeaq
1-7)