HomeMy WebLinkAboutMortgage_Burchell"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Yea
__ _; FOR DEDUCTION FROM ASSESSED VALUATION
� s� r� aa�oe (Rn i ��
�' ,,,, � Presvibed Dy �epartment of Local GovernmeN Firiance i{� �
INSTRUCiIONS:
Y
Form filed with:
To 6e filed in person w by mail with fhe CountyAuditor or Counry RemNe� of Ne oounry where fhe pmperty is located.
Fifirg Dates: 1 J Real Property Must frle dunrg Ne year /or which the deducfion is soughL S E P 1'�unry Auditur
2) Mo6ile /Manufactured Homes rrot assessed as Real Property Must file dunng Ihe hvelve (72) monNs
6e(oie Ma�ch 37 of each year tha deduction is sought. ❑ County Remrder
., v
See 2verse side (or add" � n l instructions and qua � � � N+'�
AppGcam(owne� b r�- le � 9q �re' id I /� A 7y AUOITOR
/�'. �i 1/ I( I/I / I A � / GIBSON COUN �� Q�
�Q�.�oi��,� ��Y����a��g�/����• �
eC vehie of � popMy as d �Mort9age / Contraa intleCtednrss unpaid as ot
1. amnt Y� Mamh 1. G�RW�Y�� ��
m
Name of mortgagee or contraU 5e0er (..� �-�[
�� N
Address of matgagee w wntraG seller (numbe� and sbael crty, sbte. arid Z1P.
Name of assignee w athu owner or hdder M nwrtgage —
AAdress of asvgn� �_.— -. _ _ . _ - "
�OES B��(2lll 01 � i i \ O . . . �• • • • • • • • •
counry in Ind'ena: ' 1\\' Cl
3�t49 . .....
�:,, a �o. ....�o:�:: .
DeducUOnappmve� �35
20 20 _
ryAWimr
I/ We ce' under th pena o perjury
owner I contracl buyer of the aforemenlic
' `awre(ownelslu0rem
A
uli resitl of a icant berantl sL
��Z�n�/o ;
Person authol¢ed by OWy e��ewtetl Power ol At¢
: of appfKation Iegal or epuitahle owneYi
❑ Yes ❑ No
someone oprer Ihan spouse. hdimte with whom .
Is the pmperty in QuesUm: MnuaOy Pssessed
❑ Rea� PmpeM Q A^^ua1N Pssessed
NTat Ta�dng D"striC? I Has Uis Cedutlim Ocen repueSteO at property
fm arrent yea/? ❑ Yes ❑ No
20 20 20 20 _ 20 _
CounN Date (montf�.d�/,'�'ee�l / —�
LJ`�
he above and toregoing intortnalion is we and correcl and Nat the applicant is a resident of Indiana and
�roperty on date applidtlon is filed.
n Date (rtonfh, daY. Yge/)
person (number aiM sbeet, dty, sfate, and ZIP mde)
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