HomeMy WebLinkAboutMortgage_Schwomeyer"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
s FOR DEDUCTION FROM ASSESSED VALUATION
� � sra� r«m aa�oe (R» i 5as) �
�«. PresaiGed by DepartmeM oi Lttal Gwemment Finence �� �? , � J1.- I
'1 Fi
INSTRUCTIONS: l� `a '
Form fileO wiN'
To 6e filed in person o� by mail wi(h the CountyAuditorpr Counry Recorder o/ the wunty where Ihe property is located. Q
Filirg Dates: 1) Real PiopeRy: Must fJe dudig fhe year f which [ha detluclan is soughL Q[, ���Q�{ty Auditor
2) Mo6�7e / Manufactured Home nof asse a Real Property Must 6fe danng [he hvelve (12) months
6efole March 31 of ye '� ought. ❑ Counry Remrder
� .
See reverse side /or add' ' nal i trtx a oualificatrons. ~�t a� �����
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GIBSON
T n9 Key nmber/ desvi0/��� � ' OOO. !�ob Remrti num V' P�e7 �U
AssesseC vWue d real poper,y az ot Mm[Qage ICCC000��� a intlebteCness unpaid as W Mongage I Conva'Y mEebtetl�s unpaitl a d Is Ihe epp6mnt the sole
Mar�h 1. arrem year Mard� 1. ni�^ � date of av0�� � n Yese n oN
I -�� � Y X X �
It no. what is his / her exaa sha`e at interesi9
m
IJame of rtnrtgagea «mntxt se0er
Addtess ot mat9ayee a mnhad sr�er (numbar
Name al assim�w —�
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p,�„�cr ��..........
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C�Yd �p. .....� .
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someo�re oNer ihan spouse,
te. aM ZIP code)
�t/� What Tari�g DisUict7
�_ i p— I �— I zo— I p
P�GenY in 7uesUm: MnuaOy Assessed
�I P(oPertY ❑ Mrwa�YAsses=d
0.bble Flortie OC 61.
Has Na tledu0ion Ccen �equested m pmperty
for W rtent Y�n r-i r-i
zo_ � so_
�/ ! /ty AWitarN \ / /`-`/�i I Launly� ,1 � ^ ^ ^ I Date (r+�onM. daY• V� CT � � V
1� � / �! 1/n ILL�..
p /\./1/I�\1J�C`�q/ ! �
I/ We rtify under penalry of perju that the a6ove and foregoing infortnation is We and correct arW Nat the applinnt is a resident o( IMiana arM
owner / mntract bu r of ihe aforementioned property on date application is filed.
��w2 (o�/wq�fs !y0 nai�7� /� Date (r�mtli. daY. Y��
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I^ 'd �ntlaEdress U,laDPGrant (nuC`]O e C 4 �'' Q/( �� /�f �BD C l �:�, 1- k • � ! � � a
J O J L
rson authof¢N Gy duly ezewted Pw.er o( Altorc�ey or Cy IC 67.1-12-0.7 �ate (mmN. tlay, ysa�
PEtlrrss of autlmr'vcd pelsm (number and sbee; riry. state, and LP mde)