HomeMy WebLinkAboutMortgage_Elpers (14)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ y FOR DEDUCTION FROM ASSESSED VALUATION
Sfale Fwm 437W (R71 / 609)
��.r 1 Prrsaibetl by Oepartmerd af Loral GovemmerV Finar�ce
File Mark
NsrnucnoNS:
To 6e filed in person or by mail wiM the CounryAuditw or Counry RecoNe� of the counry where the pmperty is bcated. F
Filirg Dates: 1) Real Pmperty: Must �le dunrg the yaar for which fhe deducfion is soughf. �
2) Mobde / Manu/actuied Homes rwt assessed as Real Property Must h7e dunng the hvelve �72) months �. Nb.-�'�x;A�,ditor
6efae Ma�ch 31 0/ each year the deduction is sought Cou�� Re�der
\
See reverse side !or additiona/ instruftions arM qualifications. G I BSO N COU NTY AU DITOR
iv �. . O'
rd4ie c( 2al propgty as M Mortgage / Contract iMehtedness unpaid as d Mp
1. finaY year Marti� t. wrtrst }4ar daU
I
If m, whal o his I her exac] share of interest? �f ovmed wii�
It name m remN is Cifrerenl Nan Nat of aOP��I �dirate Delow
tJartre n� rtnrcyagee or mno-act seuer �i `/"c ^
C CX
AC42ss oi mortgagce or contract seller (number eM f, cRy, sbte, aM 21P code)
Name of asshyiee or other owner or hdder of fmrtgage
AdCress ot amgnee (number aM strre4 �y. sfafe. and ZIP code) � �
Ooes appli2nt w�+� ryoperty in anY �� If yes. what munt7� 4Yha1 Tanrg I
counry in IMana?
❑ Yes ❑ No
DeCUCUOn approved in Me amount of:
zo
s�y�n�,e a c�,ry nw�m.
,;.
COUNTYAUDROR
20_ , zo_ , 2a_
cwnty
as
Y� u Na
dher tlfan spouse, iMiqte wiN wFnm
property in Question: MnuaDy AssesseG
� a�naenr ❑ nnn�,aiN as�s�d
L%%_-�_/ .._.... _ n..—n_.2�— ---
�Q P�s 3c oy �
m�x. �„� �1.LE 2
� _'
��-a9s
I I We certify uMer the penalty of perjury that the ahove and foregoing infortnalion is We and cortect a� Iha[ the applinnt is a residem o( Irdiana and
owner / mntrad burer of atorement ed perty on date application is fileC.
Sig /s � ) Date (rtrorYh. daY. Yeah
� FuA msiOeM address of appGCant (num6er nd , sta , and Z/P
�S"a � � � �sS �k�..-�;�-a..� ,J 4C7��9
Person auNO(aeE Dy CWy exear,ed Porer o( Ananey m by IC Gl.t-12-0.7 oafe (monu,. aey. yea�
AAdrass o( author'¢Pd per5a� (number arnd Stree4 dry. Ndfe, and
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