HomeMy WebLinkAboutMortgage_Richeson (5)^`n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
__ + FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 937W (R71 / 6-09)
�` , Pte5CliDeA by �epartmenl oi Loral Govemrtlent Frence
�u.
�srRUCnoNS: OCT 1 F�b a�
To be filed in rson w b mail wRh Ure Coun Auditw or Coun Recorder of fhe coun where the ro F� �� ��
Pe Y �v b b a aeNYisrocatC.'J.
Frling Dates: i) Real Pmperty Must file tlunng fhe yearlor which fhe deductlon is soughL Counry Autlimr
2J Mo6ile / Manufadured Homes not assessed as Real Pmperty: Must file dunng the tweMe (12) months
before Maich 31 of each year the deduction is sought. ounry Recorder
GIBSON CO TY AUDITOR
See reverse side for addiUOnal instructions and qualificafions.
AGP�m (o�vrer wcont2C buyer - s�e rcsMrl.bns °(i�[rverse s�e). 1
1. arienl ym
If no, what Is his / her e�act share of interest?
If nartre m recwtl is Q�IfeRnt ihan that of appficard, itMicate bebw:
����a�,�
mon�agee w
- Q7/ � (CJ o( 7 "
tleEfedfress unvaid as of
�I
stree4 uN. ffire. aM Z1P code)
rvame m azsa,piee or ourer awner or ndaer w mon9age
Address ot assignee (num6er aM snee4 Wy, sfate. arrd ZIP code)
Oces applipN ovm property in anY other If yes. wR
muM/ in Ird'ana7
❑ Yes ❑ No
Dedivaon aPWoved m IM amount ot
20 _ � 20 _ � 20
date
a d Is Ne eppGOnt tice sWe
legal «epWbde ame/?
❑ Yes ❑ No
H owneE vriM 5dneone other than spouse. utliqte wHh xtvn
GOUNTY AUDROR a �
20 _ 20 _
Caunry
Is Ihe property in Question: MmiaDyASSesseO
�tcµcSo N, _ . _
C�}2E� �
�
��-�/59'I
Has N's dedumon Eeen 2queste� m pmpnty
for arterLL yeaR ❑ Y2S ❑ NO
20 _
Da�e (rm�fh. CaY Y��
r��7
1/ We certify under ihe penalry o( perjury that Ne above arM foregoing infortnatlon is W e and mrtect arW that Me appluant is a resident of IrMiana aM
ovmer / mntract buyer of ihe a(orementioned property on date application is filed.
�rew�.(owne/s hID rmrtre) % %� . \ Date (rtmM. day. Yea�)
dry,
oy ewy
person (numbera�M sbeef, dry. state. and Z!P oode)
.�N �f?GGd
--.. I oaie pnonu�. ear. r�