HomeMy WebLinkAboutMortgage_Kiser"'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C un 7 hi vear
FOR DEDUCTION FROM ASSESSED VALUATION /�
. -,.,� • StatB FOrtn 037W (R11 / Fi09) !/
�' ,,,, Prrsaibetl by Departmerrt of Lad Govammerrt Fnance
wsrRUCnoNS:
SEP 2F�@'�rt0
Fwm Ned wilh:
To be filed in person or by mail with [he County Auditw or Counry Rewrder o/ Ne cnunry whele the pioperty is bcated.
Frling Dates: 1) Real Property: Must file dunrg the year for which fhe tleduclion is soughG G ,�Eounty Auditor
2) Mobile / ManufaUUred Homes rat assessed as Real Pmperty: Must file dunng Me twebe (12J monfh� n 4P�y
6efore March 31 ofeach yearthe deduction is saghG GIBSON C UNT'YA�I I OR ���
See reverse side (or addifional instrucUons and qualiflcafions.
- see resvirtions
i�l
share of interest?
If name on lemrd is dA(urnt Ihan that o( aDP��4 ��te bebw.
Name of rtqR9a9ee or mntract seller
- 000� 58�-009 �R���o�
ie6ted�ress unpaiC az of Martgage / ConttaG i�Webtetlness unpad as d�
_ date of a0p�cation
AddRSS of mormaoce ar mnhaG sn�ler (number arM streeG cify, sbte, aM LP code)
Name oi assi�ee w otlm! awrrer or hoWer of matgage _.-
(number anC s�ee4 �1
Dces apptinn[ oM+� pmperry in any other
munrymindiana? ❑ Yes
�
Si9nature d County n�tlimr
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If ovmeE
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Dra���er \0.....
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C�Td �0• ... '
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Counry
Yes ❑ No
spouse, ind'mate wiih whom
Is iM pmperty in Qurstion: MnuaP/ Asses,ed
�,� Rea� cROaertv ❑ Nmual!y P�sed
2quesieE m P�W�Y
❑ Yes ❑ No
� _ i zo
oa�e c„�m, ear.
I/ We cerlify under the penalty of perjury ihat the above arM foregoing infortnation is true and cortect aM that Ne appli�ant is a resident of iridiana aM
owner I contrad buyer of the aforementioned property on date appl'�cation is filed.
�,.m,�A r��.,.er� n,n i � Date (monfi. daY.Y��)
sfate,
�Y. Y��
Pddress of auMOmed person (numberantl sbee4 �: sble, and LP mde)