HomeMy WebLinkAboutMortgage_James (2)tin STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T sni vear
,_, ; FOR DEDUCTION FROM ASSESSED VALUATION
s�aca Form aa�oe (R» � 6-0s)
,' �«. l P�esoibetl by Department ol loral Govemment Firenca
File Mark
wsrRUCnoNS: MAY
To be Aed in rson a 6 mail with the Coun Audifor or Coun Recwder o/ the coun where Ihe m � �
Pe Y �Y b' �Y P PeMY is focated
Filirg Dates: iJ Real Pioperty: Must fi7e dunrrg Ne year /or which the deduction is soughf. �' �� unry Auditor
2) Mobde / taanufactured Homes rrot assessed as Real Property: Must file during the twelve (12) months
befoia Malch 31 of each year the deduction is sought. unry Recorder
GIBSON CO
Sae 2verse side (or addilionaf instrucfions alM qualrfications.
MO��i (owner�confrdGby'erYF� �Si�.°A��erse sitle) 1 �
_H `�.u� alfd ' L
w�ea �n,e d rea �ny as a
MarU 1, ar�eed y�ar
iro. what Ls his I her e�tatl shara of intrt¢st?
- 0 4�boa f a�00 R��� P��s�a�
e/ Contraa intlebte0ness unpaid az af Mortgaqe / ContrarY ciCebtedrress unpaid as of Is Ne epp6rant the sde
w /�{�) / date of application legal a eQWtade o�me!?
(//UV 10�/� rI Yes I—I No
m remtl's dY,rlent Nan Nat of aDP��• ��� �ow.
a ��
,u.v�--r-�i,
Name af assignee a other awner m halCer N mart�a9e
Adtl2ss at assignee (number antl stree4 a+Y, s+ate,
Does appti�ant oMn ryop�ty in any olher
counry in Irtlana? � _ _
za i zo
sta:e.
Dra��'er 1\'0..,�°�„�
..........
Card NO. .... S�St� �
'��CO,000.� ...
Is ihe property in question: Mnually Assesse0
❑ Rea� �oaenv ❑ am�,anrw�sed
awa� r� nc s
Has �h'ra deduction Deen reQuested m pmprlty
tw artent yeaY.+ � Yes ❑ No
zo � zo , __ � zo _ � zo _
certify under the penalry of peryury that Ne above and foregoing in(ortnaGon is We and cortecl and ihat the applinnt is a resident of Indiana afxl
I mntrafl buyer of Ne a�rementioned pmperty on date appiication is filed.
�°rrt�e hArt2(^e) .,.�/) Date(monfh.daY.Yga�)
Povmf af AttomeY,br trf
Pddress of author'¢ed person (number e�M sbee4 al: s+ale.
Date (month, daY. yea�
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