HomeMy WebLinkAboutMortgage_Memmer (2)^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C ns ip Year
+ FOR DEDUCTION FROM ASSESSED VALUATION
_— � S�a F�,�, ��� cR„ ,�, p T 14 2011
� 1 Presvibed by Department of Lool Gwemment Flrenca
4 �
�STRUCTIONS: C�� _
6e �led in person or 6y mail with the CountyAUditw o� Counry Recorder o/ Ne counry where the property is located. F� ��
Fit'mg Dates: 1) Real Pmperty: Must file durirg the year /or which the deduclion is soughG GIBSO C�YCounty1AUditor
2) Mo6ile /Manufadured hbmes rrot assessed as Real Property Must file dunrg the twelve (72) montAs O
belo�e March 31 of eaGr year the deduction is soughL Cou^ty Rec°�der
See reverse side for addifional inshuctions and�ualifications.
AnNvanlfowneraraoraraUbwer-sea reverse6ilel /1/1 1
If no,
ed vehc d �G
1, Gl�ent year
on
Name of rtnrtgagee a mntrad seller
ot aOPlxant, intlinte 6ebw.
aearess ur � «�,o-aa ��
,,�..
mortgage
ay, srare, ana t�r cooe)
Oces appticant wm pmperty in any oNer I If yes. what
munry in IMana? ❑ Y�
❑ No
20 _ � 20
Signan�re
20
3e I CaitiaH'vWebteCness unpaid as d Is Me appfuant ihe sde
aPPfi�tion lega� ar eWitade v^Tpr?
❑ Yes ❑ No
It owneC with someor�e other Ihan spouse, Indimte with whom
Is Ihe property in Question: Mnualty Ps.,esse0
�� �PQRY Q Armually Asse55ed
mA��. n��.,��
St,�.� C'
I i-y3a8
G[�I�I�[�l:i
20 _ � 20 _
Counry
20
Date (mo�rvh.
20
�
� No
I 1 We certify uiWer fhe penalry of perjur� that the above arW foregoing infortnation is We and mrred arid that Ne appli�ant is a resident of Indiana and
owner / contraU buyer of the aforementioned property on date apPlication is fiied.
irenuelownefsluqrertre) �. Date(monC+.daY•Yaa�
ss af appfxant (num6erand street �: state, aW ZIP a
� � �. �Dd S !'� �y-��
Ey Eidy exewted Power af ArtomeY a M IC F1.1-12-0.i
Mdmss of authdized person (numberaM street dry, state,
�
Date (monN. daY Y��