HomeMy WebLinkAboutMortgage_Rileye ��
^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE� 7ownship Year
__ : FOR DEDUCTION FROM ASSESSED ���{ONg� � 9 O��
y State Fam d37091R11 / 609) A Q--� c�
S d Presaibed 6y DeDartment af Local Govemment Firerce L�
�� Mark
�srRUCnorvs: DEC 2 2 11 c�� m
To 6e filed in person w by mail wiN the CountyAUditw or Counry Recorder o! the county �ere the pmperty is located.
Fifing Dates: 1 J Real Pioperty Must fife dunrg fhe year for which the dedwlim � GQU jY Cqunty Auditor
2) MobBe /ManufaGured Homes rat assessed as Real Property tif��6fOtiq Ne fweHe (�;�gfl�}s
6efore March 31 of eacA year the deduction is sought. v�\ ❑ County Remrder
SeereversesidefnraddiGonelinsVUCtionsandqual�cations. G�BSONCOUNTYAUDITOR
T O isbiti I Key rw
As�sed vWue ff real p'apelty as d
Mert:A 1. aarmt Year
If rw, what Is his / her exaU share of interest?
tl rurtre m remtl a dMerent Nan Nat of appi
Name oi mortuaaee a mntraU seller
,�1
I numbri Page mmba
GO �J —7 ,'l
M�pa ge / Contrau "uWebtetl�ress un0aid az W Mongage I ConuaG cWebttdness un7aid as d Is Me eP�t the sdN
Mam7� 7,°� O� datc of aPP�� �gal n eWitatde owne(i
"'LJ� vO ❑ Yes ❑ No
H owncd wiM someorie ocher than spwise� i�icate with whom
Mdress of nnrtga9ee or mntract se0er (num6er and sbee4 �rtl; slate, aM
Name of assignee or oNer owner w holder at morigage
Adtlress of as4gnee (numbar and stree4 �: �e.
IS OC aoperty N G�: MmWH KSSCSUd
❑ Real PropertY Q_l.Vmi°u' w_�'ed
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'`ode) �{ ]�1 �l\\`CI' 1�... �W
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'_ C�t.� 10• '� II�OiX�.d
I Dces eDDlipnt ovm poperry in any olher I If yes. wha[ munt/� I VJtul Tarin _._....... I Has Uis deduction been requested m propelty I
munry in Ind'ana7 n No for curtent yeaY.� � Yes ❑ NO
n Yes