HomeMy WebLinkAboutMortgage_Cox (8).� "'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS To ship Year
;,a,... _; FOR DEDUCTION FROM ASSESSED VALUATION
Slate Portn 43709 (R8! 2-07)
° '� Resrnbed by DepaM1menl of Local Govemment Finance
SEP ���e ��}Bg
INSTRUCTIONS:
To be filed in person or by mad wdh fhe CountyAudifor o7 fhe counly where the propeRy is Iocafed.
Fding Dates: 7) Rea! Property: Dunng the 72 monfhs be(ore June il o/ the year the deduction is to be elfective. �
2) Mo6ile Hanes assessed under IC 6-1.1-7: Belwaen January 15 and March 2 o(the year the deducfion is to be��cTiv�.`�
See reverse side (oradditional instiuctions and qualifications. GIBSON COUNTY AUDITOR
reverse
Key number / legal desrription
=a.� o� /o - — � -
2al propaty as af Martli i. arre+rt y�r Matgag
euaa
iame m record is diYerab Nan Uat oi applicantAi�dinte belar.
�! Y "� � •
ame of morlgagee ar canUaU seller --
itlress of mortgagee w mnUact seiler (number antl street, tity, stale.
Name of asvgnee w aUier owrier or hdtler
Address ot assigriee (mrtn6er and sUeet, a
Does appliwnf own property in any olher
caurrty in Intliana?
❑ Yes ❑ No
Deduction ap0�'+� � lhe amoun� oh.
2p O 20
mMgage
Reco number Page num
-ooG o0 8 't35
March 1, Is Ihe app6fant Iha sde legal «equilaWe owneR
(� I ❑ Yes ❑ No
Tf owned wiU� someone other �han spouse, uWicate with whom.
property in question:
el PropeM1y ❑ Mobile Home (IC G7.
s(ate, arM ZIP m0e)
� '^x� c R J ":"
If yes, what counry? What T�ing D'e ' �` ;;'; Y, ......:. y
Drawer NO....
4353 '
COUNTYAUDITOR Card NO
..................... _
� ���, � _
20 _ 20 _ 20 � 20 20 _
Cwnry
I I We certify under the penalry of perjury that the above and foregoing infom�ation is hue and cortect and ihal the applicants was ! were a resident of
Indiana and ovmer of tlie a(oremenooned property on Mafrh 1, 20 -
I�Y'Y=lowne/s/Ninamq). . //� i Dale(mon(h.daY•Y��
X s�tleM address ot applicant (number and sheel cify. sfale, and ZIP oode)
� 12533 E, �bO s, p.
Person authoi¢ad 6y duy erzealed Power of At�nmey or by IC 61.7-12-.07
peisan (num6eiaMSbeet.city.stafe,aiMZlPOOde)
G�o
Oate (month, day. yean