HomeMy WebLinkAboutMortgage_Ash (4)^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �!.
__ : FOR DEDUCTION FROM ASSESSED VALUATION
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�' ,.� � Prestribed by Department af Loml GovemmeM Fuiance (
INSTRUC710NS: S t
To 6e (led in person w by mail with Ihe CountyAUditw or County Recorder o! fhe county where Ihe property is locafed. �
Filing Dates: 1/ Real Property: Musf file dunng the year for which the deduction is sought.
2) Mo6de / Manu7actured Homes lat assessed as Real PropeRy Must f+le d�nng the M1velve (72) months
6ehra Ma�ch 31 of each year the deduction is soughL GIBSO �
See reverse side foradditional instruclions and quali�catio . GI°SCiN
Appfrant (ourni m conhan buyel- see res7ricGOres m le�erse " . .
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Name of nnrtgagee a wntraU seAg Q
Pdd2a o1 rtart9a9� or contraG uGer (num6Pi and sbce;
Name at assignee w oNr! ovmer rn halder of mort�age
AdEress W assignce (numEer eM stree4 �Y: ��e, and LF
eM
AudiWr
i as af Mort9a9e I ConvaU indebtedness unpaid as ol h ihe appOVnt Me sde
date a( appGcation legal or equitaWe ovmeR
❑ Yes ❑ No
If owned wiN someone dher than spouse, indrcate wM whom
Is tlu propeny in Qurstion: MnuaOy Assested
❑ Real Property Q ArmUallyAssessed
Does epplifanl am properry in any oNer I( yes. what munt/1 I What Taurg Disvicl7
munry in IMana7
❑ Yes ❑ No
COUNTVAUDROR
D�ucOOn app�rned 4i �he amount at ---
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�����,ry„�� �Ng y�oo�
I/ We ceNfy under Ne penalry of perjury that Ne
ownef ��ntrad buyer of Ne aforemerrtioned pro
S (o reme) I
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vtlen[ etldmss of appfaant (num er and sbee4 �N ��d, � ZIP mtle)
Pason authwaed Gy dWy ezewced Power of Attomey w by IC 67.1-12-0.7
Mtlress of autliu'¢ed person (number ard sLee; tAy, sble, eM LP mtle)
� P�P�Y
❑ No
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9-08 �
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�piiqnt is a residenl of Indiana aM
Date(rtmM.