HomeMy WebLinkAboutMortgage_Dewig (5)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ FOR DEDUCTION FROM ASSESSED VALUATION
� sate r-om, a97W (R71 � sm>
•� ,�,. Presaibed by DepaRmeN o( Lafal GwemmeM Fuianca �
lNSTRUCTIONS:
To be filed in person w by mai7 with the CountyAUditor or Counry Recorder o/ the counry where the properry is bcated
FiBrg Dates: i) Real Property: Must file durirg the year for which the deduction is sought U E C
2) Mo6i/e / Manulauured Homes not assessed as Real PmpeRy: Must file dunng the Iwelve (12) months
6efore MaicA 37 of each year the deduction is saght.
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See 2versa side for additional instructions arid qualifications. �%.
�iAp nt(ownerorcontraabuyer-see reverseside) GIBSO
Year
(� � �p' unty Auditnr
❑ Counry Rewrder
i rn /1 N COi�N i v AUDI70R
1S�
'7 0' ' Key �wmber / al tion Recoid numbrs Page numDer
o�b - a3-oa-�oo- oo�. 9 9o_oa o � 0 9d
vahie d rnal property as d Mortgage / Contrau 4de6te7ness unpaid az N Mongage / Contrart uWebtedness unpal0 as of Is Ne �pfxant Ne sole
Marth 7. W�ent yPar Martl� 1. a�Rni year aafe of eppfxation lepal or eQUitade rnmeYi
� O ❑ Yes ❑ No
II m, what's ho I hei eraU share of interesl? tt ovmed wiN swneone dher ihan spouse. iMrate wiM whom
It name m recad is CMe2nt Nan Mal M aDP���• indirate bebw �Is�p/� 7�P�' in Ouestion: MnuaM Assessed
�'V rceal PmPenY ❑ %'+m��Y�
a�oeue r+� nc ��.�-n
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i''�AC
W nnrtga9ee or contract sWer (num6er end street ra}: sta:e, and LP code)
of assignee w oMer owner or hdder of morigage
PdAress ot assignce (number,aM streeC
a.%���-i.v
Ooes appifant cvm p�operty in any oNel
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❑ Yes
Detluction app�ort.W in llre amount of.
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�I/ We certity untl Ne penalry of
owx mntrad buyer of the afor
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�' Fio�a�S Q ic�
Person authof'¢ed Ey dWy exewteE Pow
AGEmss of autlia'¢ed person (numbe� a
CGy, sfefe.
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Yfiat Tadrg Dist•_.^— —.wc N'a detlurlim Oeen requesteL m propelty
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COUNTYAUDROR �
DI':111'C')' 1�'�..����,,.,...
Za_ c��-� �.io. ��90
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Ne above and foregoing infortnalion is W e and cortec[ and that Me apP��mnt is a resident of IMiana aM
property on date appliration is filed.
�ate (mo.m,. aar. r��
nd sLee4 G4: �te. and LP
>Y omey m by IC 61. 42-07
5treel �M: state. entl ZIP Code)
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