HomeMy WebLinkAboutMortgage_Hill (2)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
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� FOR DEDUCTION FROM ASSESSED VALUATION
State Fo�m 63709 (Rt 1/ 6-W )
�' ° Presaibed Ey DeCartmeM af Loral GovemmeM France
�srRUCnoNS:
To be filed in person w by mail with the CounryAUditor or Counry Rewrde� o7 the counry where the property is bcated.
F�7ing Dates: 7) Real Pmperty: Must file dunng the year /or which Me deduc6on is soughf.
2J Mobde / Manufactu2d Homes not assessed as Real Property: Must fiie dunng Ma twefve (72) months
before March 37 of each year the deduction is sayht.
See 2verse side 7or additional insVUCtions and qualificatbns.
Applic.�l (owner m mntraa buy�j- see resbi^bons m�everse side) . � '' "_
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" o�(p ^ ! y -I � - o
Asessed �24�e cQ mW P�P d M1bRgage / Contrart u
Alamh 1. aarent ym MarM t. artent year
If ro, what is his I her exaG sl�are of intemsi?
11 name m recpd is CiRerent Nan Nat of appGCant, InEinte 6ebwc
Name W rtiortgagee or
�-000,
edness unpaid az
AAdress N rtnrt�jagee or mntrad setler (nu�ber and streef, cAy, sta.e, and LP
Name of assignee w oMer owner or hdEer of nnrtgage
AECress ot ee (num6ei and sbee; ttiy. slate. and ZIP cade)
�a�t-oCVr� 2a�-d- # � o�-
Dces apptiranl own property in any dher If yes, what muny?
counry in Ind'gna? �._ �_.
zo � �
couNn
zo zo
If
J,�] 2c�u�(�Caimr
C ❑�..� niy Rer.order
GIBSON COUNTY
I aemb �n� F
'��% �i � J
�e I ConTact'vWeMedness unpaid as of Is Ne app&ant the sde
appG�ation legal w equitable rnmeY?
Q � v ❑ Yes ❑ No
dher Ihan spouse, iMrcate with xiwm
�Is C,ce.� /property in puestion: Mtwalty AssesSeC
LVx�� �P�Y ❑ Mnualy Assessed
a�f t
VYhal Tarim� D'SIriU?
\UDITOR
�
Counry
Has Iha ded�Ktion EeP.n reGuested m V��+�Y
- � � �� ❑ Yes ❑ No
NS� J U N�J p �-
��L✓� L
�l - �5/5
I/ We certify under the penalry of4%rjury Ihat the �l%ve and foregoing infortnatlon is We and corteq arW Nat the appivant is a 25ident of IMiana a�n,
owner I contract buyer of the afaementioned property on date appivalion is filed.
inaRy�(oxneh fid nartre) ( � Date (�fi, daY• Year)
�l/ ' /7 . `7_ . `7 �/ O
Full resiEe�n/t a0tlress of a/p�pJ irant (n/um,6e_i andStrB/��4 rlty, slate, nd ZIP/aode) /
/// �' `G'KY�_ Y/�' ��(cC..ZR
Person auUror¢eE �y Auly excwted Power of Anomey m by IC 61.1-12-0.7
MEr�s of auCror¢etl person (numberand.wee4 dry. s+afi. antl LPmtle)
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