HomeMy WebLinkAboutMortgage_Andis^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ _� FOR DEDUCTION FROM ASSESSED VALUATION
. . �'� Slate Fortn 93709 (R71 / 6-09)
�,�,� 2 PrewibeO Ey DeP����� af Loml GwemrtreN Fumnce
File Mark
�STRUCTIONS: `
Form iBe �
!o be �led in person or by maif wdh the CountyAUdifor or Counry Recorder o/ the counry whe2 the propeny is located.
Filirg Dates: 7J Real Pmperty: Must file during the year for which the ded�ction is soughL � C ps r
2) Mobile / Manufactured Homes not assessed as Real Property Must h7e dunng Ne fweHe (12) months
belore March 37 of each year the deduclion is sought.
❑ Counry ROEorde`
See reverse srcle (or additional inshuctions and qualificatrons. GIBSON � ��-�'' "�
ra � '' Key rnimEer / I aesai Uon
d'��--1,� -d0
Ass�ssed vahc d mal p�operry as of Mongage / u�Cd
MarU 1. nmmt ypr Martl� 1. W
�/
If ra, what "s his I her erau share
�.�.iT"i''-
of �rortgapee m m�trad se9er
Address o1 mon�agee ar mnbaa
Name of assi9nee or othel avmer or
i
Sigrianrte
6ebw
��l`........
Dra�ver��•••......
5��y...••
Card��• ..�� �. �
�l ��
_ i p— �
I I We certify undes �he penalry oi perjury Mat the
owner I mntract buyer ot the aforementioned pra
�-o�po•3u3-Obc� �
unpaid az N Mortgage I Cmvxf i�eMeAness
-..�'rT'�"•L'�1
spouse.
Retord number Page mmiCel
$SG
unpa as of Is Ne applifant the sde
�egal or epuitade owneR
❑ Yes ❑ No
ls Me P�PeRY in Ouesoon: MnuaOy Assessed
❑ Real Pruperty ❑ lvmually Ps5es5ed
rt� Whal Tarin9 �isGid? Has ihis tleCUCtion Eeen re9uestetl m pmpcq
far wrtem yea(1 ❑ Y� ❑ �
couNTV nuorroR
20 20 _ 20 20 _
Caunry Date (monlh, daY. Yee�
(oregoing infortnalion is true and cortecl and that the applitant is a resident o( Irdiana and
� appliration is fiied.
/ Date (rimfA. daY. Y��
lEi9`/ S� �Kc �';r Fra„cr�co /A/ �l-7
aNhaae� Oy tlWy eseqRed Pow¢r d Aitomey w by IC 61.t-12-0.7
Pdtlress of aulhor¢etl persm (numDeiaM stree; crty, state,