HomeMy WebLinkAboutMortgage_KieselSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS c own ar
�. _ FOR OEDUCTION FROM ASSESSED VALUATION {
Slate Form 63709 (R10 /11-08) � J
` f Presaibed bY �rtrtent d Loral GwemmeM Firen� '
INSTRUCT70NS: �U le
To be fded in person or by mad witlr Me CaunfyAutlilor d fhe county where (he poperty is located.
filing Dafes: i) Real Properly: Musf Ide dwing the yeor for which the dedudion is sought `�'i�f /�
2) Mo6de / Manufectured Homes rrot essessed as Real Property: Must file dunry tl�e tweNe (12) mmUu belo� M ?�d yee�
the dedtictlon is sayhL
Seereverse9eeforedddionalinshudionsandquelificaGans GIBSON COUNTY AUDITOR
Ta�dng D'oUicl numb
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wed rdue d�I papery as d
Mart3� 7. airtaN ypr . .
M ro, what is ha / har e�ad share d ir�9aresY7
tl�ma m rawd is ddfarard lhan Ihat of appfim
Name d morigagee or mntred seAer
-oo�. D8? -D a
nearess d mortgapea or contraa senrl (�amnc�ane abmL oN. �, ane zlP coeo)
Name
a holtla af mortpaBe
as
a o.�ea wn someone aner u,a� sw�. w�ra+e wnn v.fian,
Doas appGcan� own poparty in arry dher I H yes. wimt oourvy! � VJI� Tamg Ois4id7
cowty in Indiata7 — - � –' — �
❑ Yes ; .����� (Y� _
Z!`^" ��{ � 9 _
DI":11YC1' ��....��.1...... _
flalrNim ammual in Mn amrrr�l �-
zo� Zo c:,��� �o. ......!`! 7b......
i' �1$a,CA`� � �
u�� a ca,mr mm�« � ....�n,
a
Yes ❑ No
Is ma wocem h a�re�a,: amuaM Assessae
� Real PmpeAy ❑ Mnuallyl�ssessed
Has this dedudian baen requesfed on pmpeM
m� a,�m y�n
❑ Yes ❑ No
zo _ , za _
I/ We cerrofy unda the penalty of perjury Nat the abave aM faegdng mfortnatbn is We arW oorrea an0 that the a�cant is a 2si0ent oi India� anA
owner I mnGact buyer of Me aforementbneC poperty on date applkation is filed.
��lure (wvmYs fim name) � ^ Data (morW, Lay, yea�
S�ADT JTd✓ �/��3
w by IC 6-1.7 d2-0.7
daWhaiZedparson (nvn6vandsfloM,tify,ffife.
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