HomeMy WebLinkAboutMortgage_Frederick (4)^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun rownship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
�. .� �' Sfate Fortn 93709 (RN ! 6-09)
, t Presai0ed M DePzrtmeN o( Lncal GovemmeM Firenrs
File Mark
INSTRUCTIONS:
fil
To be filed in person or by mail with the CountyAuditor or Counry Reco�der o/ Ne county wAere the pioperty is located.
Fi7irg Dates: 1J Real Pmperty: Must file during the yearlor whirh the detluclion is sought. � AuEitor
2) Mo6de / Manufaclured Homes irot assessed as Real Property Must file dunng the hvelve (12J monfhs ❑
before March 37 0( each year the deduction is sought " �def
Seereverseside7oladddionalinstrucUonsantlqualrfications. GIBSON UNTYAUDITOR
. ' I Kev
Atarch i. aim�v IRar
If no. whal is his! he
It name m mcUN s�
mnga9ee or oonvact seuer
li6%4� l — C�Q
� / Contract'uWchtedness
wrrem ye�ar
maKate eeww _ �
ciry, sate. aM 2
Name of ass9�ee or otl�nl ownet w holder o( mortgage
AilCress o1 assgnee (number aM stree4 �y. s1e1e. antl ZIP code)
Oces a�imnt own WopeM1y in any other If yes, wh
munry in Intlaria?
❑ Yes o
approved In ihe amoum
' � ^ (
npaid as o( Mongage / ConvaG mdebieC� �mpaid as W Is Me sppCcant Ne sde
Aate W ePW�� lagal a eCURa61e amM
— � Yes ❑ No
tl awned v�ith sortwrne othr� �`� M whom
— �u`t. �:�„�
ra��er1�0• •• ••.. �' p� �,.,-
D �.,z C�19 .
CaY �r` ,j�\�-V"
`;1V
COUNTY
What Tadng Districl4
requested m
❑ Yes
20 20_ 20_ 2�— 20— n1— p—
(awre d CoumY nuditor Counry Date (monN, daY• Y��
I�/ We certify u�er ihe penalry ot perjury that the above and foregoing infortnatirn is W e and mrrect arW ihat the applirant is a resident of IrMiana arM
owner I contrad buyer of the afaementioned property on date applicavon is filed.
ot a��ant (wmber an0 sbee4
P�rson auNOmed Gy Auty e�lcuteE Porer af Attomey w by IC
Pdtlress of au0�orrzed pr.rson (number arM street. dry, sbte. a
47(D�n U
oate crxx,m.