HomeMy WebLinkAboutMortgage_Maikranz (3)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
�:-
= FOR DEDUCTION FROM ASSESSED VALUATION
� � State Fam 43709 (R71 / 6O9)
�` ,w� � pr¢smbed by DepartmeM af Local Govemmenl Frence
File Mark
� INSTRUCTIONS: �, U G �
To 6e (led in person or by mail wifh the CountyAUdito� or Counry Recorder of the county where the property is locat
Fifirg Dates: 7) Real PropeRy: Must fiJe dunng the year /or which the deduction is sought. County AuEitor
2) Mobde / Manulactured Homes not assessed as Real Property: Must file dunng the hveNe (72) rtronths ���
before March 31 o)each yearNe Aeduction is sought. �ounry Recorder
See reverse side (oradditional instructions and qualrficatbns. GIBSON COUNTY AUDITOR
P.p t(owneror contrdrl buyer resvi�or�s m ieversLe, �side)
y � i �[%LQ% � • �
Tad Distrifl Key rnimber / legal d�aiption Remrd numbu P numbes
No-/8-36-/oi-ood. 3o8-oa-y ol�- �✓SG�
rdh�e d mal propeny as of Mor�qage / Cantract indebtedness unpaid az of Mortgage / Contraa iMeMed�ress unpaid as o( Is Ihe applkant Ne sde
Mazd� 1, dmrnt year Martli 1, airtent yeer Aate of appGtatpn legal or equitade bwne(1
62 ❑ Yes ❑ No
tt no, what fs ha I her exar� share of interest? tt wmed vriN mmeone er ihan spouse, iMicate wilh whom
If name m rea�N is tliflerrnt lhan fhat ot aPP��C mdicate beloM'. Is the perty in 9���^: �nua0y Assessed
eal �openy ❑ a,��ny a�sessed
Modle Fiome IC 61.L7)
Name M nwrt9a9ee ar mntract se4er
Address W�mnJa9ce w wntra vA (neuri6�and 4�Y. state. eM LP code)
Name ot assi�ee or oNei wmer or hdder of rtnrtgage I,
Aadress of asvgn (number arM s1meL rJry, sfat a� Z/P ootle) �� ��
Dces appl' nt own property in any oNer If yes. whel m What Ta�dng DisUicl7 Has �h's tletlurtion Eeen 2quested on P��Y
counryinln0'gna? ❑ YES ❑ No forartentyeaR ❑ YPS ❑ No
� COUNTYAUDROR
Daiumon approved In �he artwum at
20 20 2Q 20 20 ' ..— ..____�
sg�n,remc«u,� cW�n Dra,�� er:iYO.:°�1 �...�.
I I We certify under �he penalry oi perju �hat ihe abov foregoing infortnaGon is We and ''' � '� ��
owner / mntrad buyer of the afaementioned prope date application is filed. , C;] �-� • j�iO � $
�� —
Sig (a er's MI neme
h � . :. � aYg��g; � ' ` -
FWfre4tlentaddressolappi'rcam(numbera stree ",s7ate,aidZlPCade) ' ^� '
S. ,;.I a S�— �b s+� -�- �-� s
Pasrn aWw(aetl Ey dtdy exewte0 Power a(Atlorney m by IC .1-12-0.7 Date (rtb�M. Cay. yEe�
AGEress of a WwmEd person (number aM SLeef, dry, sfate, arM LP code) .