HomeMy WebLinkAboutMortgage_McGregor (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDE TEDNESS �oun Township Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION ��
� StateFwm43709(R71/6W)
�' ,,,. � Presaibed Ey DepahmeM of Local Govemmenl Finance
OCT 2 0 2009 FileMark
INSTRUCTIONS:
Form filed with:
To be filed in person w 6y mail wifh the CounryAUditor w Counry Recorder ollhe tounty whe2 the pioperty is located.
Fifirg Dates: i) Real Property: Mus! file durirg the year lor which the deduction is sought �� ��� Counry Auditw
2J Mobde /Manulactured Homes rrot assessed as Real Property: Must file dunng'the fweHe �(i2) months
6eforeMarch3lofeachyearthedeductionissoughG GIBSONCOUNTY UD�TOR �nryRemrder
See reverse side 70� additional instnrcUons and qualifications.
MW�nt(yxvl�racontrartbuyz�-see�on;onrererseside) \ /�.� /1 i �
Tanng /7� Keynum0er/Ie9aIGe5mOtwn fremranumoPi rage mcer
`/ a 6- - cn -«.� . � � -oo � 9 y -
Asetsed �-due d real propel;y az d M�r�� ge / Confraa'udehtedness unpaiE as of Mwtgage / CantraU rtWebteCnrss unpaid as of Is Ne app&'ant the sde
Mavl� 1. wreN year Mamh 1. n�rtent date of appG�ationU legal w equitaOk wnell
� �QdO ❑ Yes ❑ ND
It m. whal ts his! her exa�Y �are of inlerest? If wmad with someaire other than spouse. indirate with whom
It name m remd is EiRemst Nan that o( appOCani, ind�cate Ceb�r. Is the property in Question: MnuaOy Assested
I PropP,rty ❑ Mnually ASSesSed
Mohle Honte fIC 61.1-1
Name of mortgagee or mntraU seAer
PGtlrea o1 mxtgages or mntrad sed
Name ot azsignee or othu ownet or Y
state. ard ZIP code)
AdCress ot assignce (numDer end street uN, s+a+e, and LP cade)
Does a�nt awn property in any oNer If yes. wh:
cou�ryin^ndiana? ❑ YES ❑ No
GOUNTY AUDITOR
DeducCm aGP�'d in ihe
DI'11f'CI' ���:7�`�!9........
5Y�3'�'' -
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I No
20 20 20 20 _ 20 20 20 _
Signawre d Coun�Y Aueimr Counry Date (mon(h. daY Y��
I/ We certify under the penalry of perjury that Ne above and foregoing infortnalion is W e and cortect arW Nal Ne applicant is a resident of IrWiana and
owner I wntract buyer of Ne afaementbned property on date appiication is filed.
��(ow^x/s MI na/m�e) // /J Data (monfh. daY. Yeeh
A M-�-� I .lM A / / t l� •'✓ "`�S!% �
FWI resiEent address o( appfnant (num6eiarW sbcet . slate, aiW ZIP oode)
�/07 0 9� C 2 ia5 S. f�Qa��,(� C�;-� ,�nl �7� �a
Per„on auttroraed Ey duly exewted Power of MomeY � M IC 61.1-12-0.7 Date (rtronN. day, yearj
(number aM streef, ciry, state. and