HomeMy WebLinkAboutMortgage_Miller (16).+°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_� FOR DEDUCTION FROM ASSESSED VALUATION � ��
s�a F«m az�os �Re i z-0��
�� j Presrnbetl by Departmenl of Local Govemment Finance
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de Mark
INSTRUCTIONS: AP G (ii(;;
To be filed in person or by mad wdh the CountyAuditor of the county where the properfy is kcafed.
Fding Dates: lJ Real Property: Dunng the 72 months be%re June 17 d the year the deduction is to be eflecfive.
2) Mobile Homes assessed under IC 6-7.7-7_ Behveen January 75 and March 2 of the year the deduclion is to h��Gfiv�
See 2verse side 7a addifional instructions arrcl qualifications. � �'
GIBSON COUNTY AUOITOR
Apqicam (owner ar mntrad buyer - see resYfic6ons on reverse si0e)
Ta�urg DisUicl , K num / legal descri ' _ Remrd number Page number
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2al property as oF Martl� 1, qrtenl yesr Mor�a9e I Conirad inde6tedness unpaid as o( March 1. Is �he applipnt Ihe sde legal
anrent year 1
� S S.
her exaG share of interesl? If owned wi�h someone olher lhan spouu, irWicale wilh wtwm.
If rvme m record is d'A(erenl than thal of applican4 ��icale below:
Name of mortgagee orcontrsct seller
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Adtlress of mortgagee w mn sellea (numbu aiM .Neel, aty, state, and
Name of assignee or oUrer o.vner or hdder of martgage
Address of assigrree (mm�6ar and sfreet. dty. slafe. aM ZIP cUtle)
�oes applicant own poperty in airy other If yes. what caunry
counry in Ind'ana? p�
6I,Wes � No
Detluction app�oved in Ihe amwnt of:
20 � b � 20 � � �1 � �
agr¢wreo�wunrywww `XI I"
v d
I/ We certify under the penalty of perjury ihat the above and fwegoing
Indiana and owner oi fhe aforemenfioned property on March 1, 20
SigraWre(mvners7Wlname) n r� _ �
exewted
w ny
and
U
Address of aulhor¢ed persai (number arM strcef, dfy, sfafe, arM ZIP code)
Is Ihe propeM1y in quastim:
❑ No
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