HomeMy WebLinkAboutMortgage_Helfrich""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ + FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Farm C3709IR71 / 609)
\ / PresaiCetl M �eVartment of Lool Gavemmenl flrence
File Mark
INSTRUCTIONS: ^ ^ '
To 6e filed in person o� by mail wifh the CounryAuditw or Counry Recorder o( the counry where the property is located. � � V
Fil'mg Dates: 1) Real Property: Must file dunrg Ihe year Por which the deduction is wughL � County Auditor
2J MobBe / Manufadured Homes not assessed as Real Pmperty Must file durirrg the IweNe (12) marths
before MarcA 37 0! each year the deduction is soughG �� � ��
See reverse side (or addilionaf instrucUOns and qualilications.
MP��� (owneror conj�Ct �yer's�rasnicbms m rev jr� side)
7, tl�rt year
n no. what is nis � rrer a,acc share of intr�n
U name m ramd is AiReren[ Nan that of eppOnn; hiEinte bebw:
Nartre of mongagea w mntrsct seller _ ./" /�
Name of asvgnee w oNu wmer w halder o
azU
��
GIBSON COUNTY AUDtTO
impaN as M � Is Ne
If owne� wiN somewre Whar than spouse. iMimte with whom
Dra`ver NO..�Q�(�...:
c�„�,��t�, �ai•d i��'O. ..,.—�.r.91�%
5 3 .........
D�PPM1Y in any oNU � �a,OIW. �
❑ Yes ❑ No
Is ihe Pm7enY in O��estian: MnuaM AssesseE
� Real ProPenY Q Arm!�al J�
Has Nis dedud'nn baen reGUes4M m P�openY
for wrtent Y��' ❑ Yes ❑ I
COUNTYAUDROR
DeducGm aGW� in tlre amount o`
20 20 20 _ 20 _ 20 _ 20 _ 2(1 _
SignaMe o( Camry Audbor Caunry Date (rtx>nM, tleY. Y��)
I/ We certify under ihe penafry of perjury Mat the above arM toregoing infortnation is W e and mrtect and Nat the applinnt is a resident of IrWiana aM
wmer I ntract buyer of the afaementloned property on date application is filed.
wne/: fiN iro ) � Date (rtmfi. OeY. WaA
la/l3 0
F rnsident a0tlrass of appfcant m0er antl sbaet �Y, �re, and LP cade)
Pason autM�¢e0 Oy dWy execu'sd Pwer ofAttomey w by IC Gt.t-12-0.7 Date (rtrond+. daY• Ye�
MCress of authaaetl pr�son (number antl sbee4 �Y. state, an0 ZIP code) .