HomeMy WebLinkAboutMortgage_Hofman^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 637W (R71 / 609)
� 1 PresvibeC M DePM�M o( Lowl GovemrtreN France
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INSTRUCTIONS:
Fotm Poed .
b 6e ned in person a by mail with the CountyAudifw or Counry Recorder of the county whe�e fhe property is locafed.
Filing Dafes: 7) Real Pmperty Must fJe dunr�g fhe year for whicA the deduction is sovghL Al0 V s�"Counry Auditor
2J Mo6de / Manufacfured Homes rrot assessed as Real Pioperty: Musf file dunng the hvelve (72) months�
before March 37 of each year the deduction is sought County Recorder
C J.
See reverse side !or addiLOnal inshuctions arM qualilicatiuns.
t" or uyer� see mreverseside) GIBSON COUNTY AUDITOR
�y
Ta o �Ya ���a.3 i- aoo - oo�. ���- od �,°o P���o
vehx d real yopeM1y as d Mort9a8e / Contraa irdebteCness unpaiE as o( Mortgage / Contrafl intlebtedness unpaid as d Is Me appfxant ihe sNe
1, aa�ent yqr March 7, qirteM year ;1 date of aPP��b^ �egal w equilaWe ameR
�Q� ��ii ❑ Yes ❑ No
K M. W�Id� 6 �YS � h2f Cl2G S�INB Oi V1iClPSl�
1( narne m recwd is tliRerent Nan Nat ot apptipnt.
Name m mortsagee ar cmvaa
Mdress of mortgagce ar mntra
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(numbri end sneet, ciry, state, ard LP codej
w dner owner rn im�aer rn mor[gage
Oces applicant own poperty in any oNer
munry in IMena? n .,"_
ot
20 � 20
state, aM
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owned wiM mmeo�x other Nan spouse. W Kate wrtn wrom
ts C�e m GursGm: MmWN Pssessed
eal ProPenY ❑ �Y �
r� r� nc ��.
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t What Tabrg DaVal7
COUNTYAUDROR
20 _ I 20 _ ' 20
Dra�ti�er NO....a�„� `
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e3Nc�dno.... .....
• � l9g,�09. $9
20 _ � 20
�ture W Camb Audnw Caunry Date (monN. daY. Y��
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I I We certity urWer the penalry of rjury Ihat Ihe a and faegning information is true and cortecl arW Nat Ne applicant is a resident of Indiana aM
owner 1 contract buyer ot ihe afwementioned pro on date applicatlon is filed.
FWI a�Ness W appran umcer.
/1'{9 S, �s 6 _. k
Psson autlnraed Dy tlWy executed Parer
Addressofautlid'ue0person (numberarc
ci(}; sbte. enO ZIP mtle)
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