HomeMy WebLinkAboutMortgage_Overton^`n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ .� FOR DEDUCTION FROM ASSESSED VALUATION
� Sta[e Fortn 63709 (R71 / 609)
��«. � PresaibeG M DePa�M of Local Govemrtrerrt Fnance
File Mark
�sraucnoNS:
be ((ed in person w by mail with the CounryAudROf or Counry Recorder o/ the counry where the pioperty is located. � W
Filirg Da[es: i) Real Property: Must file durirg the year for which the deduction is sought _6ounry Audimr
2J Mo6ile / Manufactured Homes not assessed as Real Property: Must file dunng the fwelve (12J months `I—�
before March 37 0! each year the deduction is sought. LJ � e�e�
See reverse side toradditronal instruc7ions arid qualdications. GIBSON COUNTY AUDITOR
AppGCant (owner oro�aC 6y2� -�e restrictuns m reverse vde) ., l. .�
AsusseC vahie cf real p�operty as of
AlarN t, qrrent yrx
If no, what is his / her e�1 slure of interest?
If name on record "5 OiRerent Nan Nat of aDP���• �ndirate bebw
mort9agee or mntrarl seDer
or oontracl se0er (numDer and sbee4 �'Ay. sfatB.
Name of assignee or Wher owner or hdder of rtartgage
PDAress ot asdgnee (number aM stme4 my. slafe, antl ZIP cotle)
Does applimnt awn property in any oNer
munry in Ind'ana?
❑ Yes
2� � 2�
If yes, what munt�(?
�
20
�
unpaid as U Abrtgage I Contraa
tlate of app&ation
`Mia1 Ta�dm� DisMct�
Recortl numbe� Page numbnr
' b I�
Iness �m7ai0 as W Is Ne ePP��t tlre sde
legal or epuitatle ownM
es ❑ No
,se. indiUte wuh �vhrnn
� wocenv m C�arnn: amweM wssessed
Rea�aiopeny ❑,Mnualyassessea
Mahle Fiartie OC 61.7-7
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�/ We certity under the penalry o( perjury that Ihe above and foregoing infortnation is we and cortea ard Nat the applirant is a resident of Indiana aM
rnmer / mntracl buyer of Ihe aforementioned property on date application is filed. �
street. a1y, stare.
auNOr¢ed Ey tlWy erecuted Power of AtlomeY a M IC 61.1-12-0.7
Address of aufhor'ved person (number ami svee4 ary. s+ate, aM ZIP cotle)
Date (ma�M, day, Year)
/ �/ 7 �,
�f 76 3
Oate (monM, daY. Ysa�