HomeMy WebLinkAboutMortgage_Seramur"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Yea
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fam 93709 (Rit / 6-09)
` ` Presaibed M�D��rrt ot LoW Goremment Fuiazm '
� ile
INSTRUCTIONS: F� �� �
To be fi7ed in person a by mad with Me CounyAuditor w Counry Recorder o( Ne counry whele the pioperty is bcated.
Filing Dates: 1) Real Property: Must fde durirg the year for which the deduction is sought J N� 0�Q,�,9 qudimr
2) Mobde / Menufectured Homes rat assessed as Real Property: Must file dunrg the fwelve (72) months
6efore Ma2h 37 of each yeer Ne deducfion is swrc�ht. ❑ Cwi^ty Recorder
See reverse siCe for additional insfixtions and quali(cations.
orcontraC6uyerry-seercsbijliwumre�rrseside) n GIBSON COIINTV el�nirno
d
' � i. a+reirt Year
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If rq, what Is his / Icer e�d shara
tt narne m recv�tl e 6Hemnt than
Name M nartgagea a mntract seUer
ndaRS ot mart9agce or m,o-aa seo
r�a w�ee or an� �� a r
Meress o/ augnee (numbar erd sL+
-� � -
, / Contrau irc
airten[ yrar
a7P�Cant. IMipie Eebrr.
any oNer
Yes
apryoved in tlre amount oF:
iendsbeel �¢j: s�ate. aM:
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ste. eMLPCOtle)
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No
I� �i�'��
WhatTering
� o(o/o (avb
�bte0ness un7aid as d La Ne appfmant tha tde
kgal a evWmde v�t
U f� ❑ r� ❑ No
spausa. IMicete wiTh whom
yIs,�Q�e propeM1y in Question: MnuaAyA1sctsed
�p.JR221P�opertY Q!vmualhl�.._
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Dra��•er NO.�
Q.�U........
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I 1'�, ��. �c/
20 20 _ 20 20 _ 20 _ 2q _ 20 _
�renne d Camh nWrtw Caunry Date (munth. daY• Y'^��
I I We cerrofy under the penalry of peryury that Ne ahove arW foregoing infortnation is true and corte�Y ard Nat the applirant is a resident of Indiana aM
ownqr I contraU buyer of the aforementioned property on date application is filed.
�naW�re (owne/�N9nama) C' Date (monm. daY. Y�/)
streeL
Pelson auUw�aeO Dy dWy ezetuteE Porer of Attvney w by IC.�1.1-12-0.7 :. I �a� (�. dfi: Y��
Address o( auCmr'ved person (numbar aid SLSeL �: sbR, and LP crotle) .