HomeMy WebLinkAboutMortgage_Elpers (16),
^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
,_,. , FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fartn 43709 (R71 / 6-09)
� y„ � Prewibed by DepaRmeM o( Loral GovemmCM Firunce
INSTRUCT70NS:
To be filed in person w by mail with the CountyAuditw or Counry Recorder of the county wl�ere the properry is located.
Filirg Dates: 1) Real Property: Must fde dunng the year /or which the deduction is sought.
2) Mo6de /Manufactured Homes rwt assessed as Real Property Must file during the hveNe (72/ months
6efore March 37 of each year the deduction is sought.
See reverse side (or addit'anal inshuctions and qualifications.
��� (�wiY4'�°^++aC� buyer- see re;trir�ms wf�yerse sidqL
—r x �
f value a mal qopeny as
arreM year
110. Wh8[ 6 ht5 / hPlB%ZCI Sh8f8 0(
If name on mmN a SMrlmt than that of aPW��4 mdiqte Celow
Nart�e ol rtnrtgagee or rnnVaG seller __
ACd�ess W nnrtqagee or contract seDer (numbr� en
Name of assignee ar otha vwner rn holdu of mortg
Atltlress ot azvgnee (number and shee4 �Y, s+afe, s
Oces applifant ovm properry in any other
munry in Indana? I-'1 .,_ _
az
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D���,,.���.o..��..ab.�.
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�Wo�oi3�aJ�. ��
GIBSON
RecoN numDe
SPO1152,
LC��Jun[ry A�jund+it'or�
CCunfy &i�ttler
Yes LI No
Is Ne properiy in puestion: MmiaDy Pssessed
❑ Rea� Proaenv ❑ ,wmua�H assesud
Mohile Fiortie (IC 61.
ma aea�e� eee�.ea�esrea � v�nr
urtenl yPa(! � _ . � .
COUNTYAUDROR
Deduction approved m 1he amoun[ of: '
20 20 20 20 20 20 20
Sigianne at CambAUEitw Counry Date (rt�orvh, day.lTa�
I/ we certl(y uMer the penalry of perjury Ihat the above and toregoing infortnation is W e and corteU and that the applitant is a resident of I`Wiaria and
owner I ntract buyer o aforementioned property on date application is filed.
� ature hi0 na Date (rrn�rth, day, yse�
��U appfrcant (numDer and shaef. dry, state. ard ZIP code) � �� ��
S W er
erwn auNO�rzed Ey Euty ezewteE Powcr of AvomeY a M IC 61. t-12-0.7 Date (monN. Qay, yea�
Mtlress d aulhuaeC person (number aiM sbeet trty, stafe, and ZIP cade) .
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