HomeMy WebLinkAboutMortgage_French^�n STATEMENT OF MORTGAGE OR
:. =—
� FOR DEDUCTION FROM ASSES:
.• Stale Fortn 437W (R71 I6O9)
�' wa � Presaibetl by DePanrtrenl W Loml Govemment Frerc. . I 7/
MAY 11 'tJ,-
�STRUCTIONS:
To 6e fiied in person or by maii with the CountyAuditor o� County Recorder oI the caunry`iwh� p ro p erry is kcated.
Fifing Dates: i) Real Property: Must file dunng the year (or which the deduction is soughf. g �y� t�1
Z,beforeMarch37oeachyearlhedeductionissough��PeGIBSONCOUNTYAU �rtmonfhs
See reversa side for additional i ctions and qu�alfications.
rowmmc�e.a�ce� - � m�e,�e , „ _. � A.
Assessed vdue U real poperry as of
MarU11,amMLLymr
If ro, what is ha / trer exaa sharo of
If �Ine on �ecad "a ditfettln tt�2n N
Name of rtnrtgagee ar Cmtratl5e0er
KeY nunber I Ieqal drsrnp�on ��^� ^ C�lo —OOO .
� _
� ( !J (J
�rtgage / udebtetln¢ss unpaid az of dMOBgafpe�P�Ui
ich i a�ar� � �OO
�gyt{7 �� � If owneE wiM someone d
maKate cerow
� �,13�,��I.�
_ , ao� a........
F Dra,���r �o........
0
a 7 ��. . . � . . . . . .
_ C�C(� \0. .........
¢pp�oved 4� Ihe amount of.
20
rd LP code) U
n vme� r� o�sm�+
cour+n auorroR
File Mark
Fmn t�ed wiN:
� CounlyAuditor
❑ County Recorder
Recortl numb O Pa9e nujp �
) / CT
�moaid as of is ihe aDd�i Ne sa
I ❑ Ye5 ❑ No
spouse, iM'vate xiN whom
� me wwem �+a�essw,: nnn�zur r��ssea
❑ Real ProPeNY ❑ �^!!�.Y � . . -
20 _ I 20 _ I 20 I 20
1 I We ceRify ufWer ihe penalry of perjury �t ihe aDOVe and
owner I contrad buyes of ihe aforemention�Q properry on da
addrrss o1 aPP��t (nulnber and sfleet, riiy, slate, arM ZIP ca
533� E �oo S r���_�
xrsed by duty executed Power ot Attorney or by IC 67.1-12-0.7
uthor'ved puwn (num6er aM stree4 ciry. sbte, and Z!P code)
requested m propn+ry
20
co�� I Date (�rwMl,. aar r�n
infortnalion is we and correcc arW that the applipnt is a resident of Irdiana arW
ion is filed.
Date (rnmfi. daY. Y�e�
daY. Yea�
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