HomeMy WebLinkAboutMortgage_Malone (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:,--
= FOR DEDUCTION FROM ASSESSED VALUATION
• State Farm 43709 (R71 / 6O9)
�• i PresrnbeE by Department M Loral Goremment France
File
INSTRUCTlONS:
To be filed in person w by mail with fhe CountyAuditw or Counry Recortler o! the county whe�e [he property is located. � K' �
Fi7irg Dates: 7) Real Properly Must fJe durng Ne year /or which fhe deduction is sought. �e nry Auditor
2J Mo6de / Manufactumd Homes not assessed as Real PropeAy Must file dunng the twelve (72) months N � Z U 14
before MarcA 31 of each year the deduclion is saght. Counry Reoordu
See reverse side iUOnal inshuctions and qual�cations. C,
npp6rent(owrerar tractbuyer-seqr�tnrm revers i e) �n / � GIBSON COUNTY AUDITOR
�i � V
'rg Distr¢t Key num / al desaiplion Rem(d ruimEer Pag u
- 3 -aoo-D a. - �.�
vaNe af real p(apeny es of Abr�qage / Contract 4dehretlness unpaitl as of Mortgage I Contrad i�ehtedness unpaid as d Is IAe ePW�t tl�e sde
1, anmt year Marr7i 1 artrent r date of appfiotion legal or eQuilable axTwl.+
� ❑ Yes ❑ No
It ro, what ¢ his I her eraa sl�are of interest? If avried wiM sameore dhrr Nan sppue.'umdicata w�h wlqm
If name on record is ddferent Nan that o! appficam. uMirate hebw: is IM qoperty in Qunstion: MnuaAy Asessed
❑ Rea� a'oaenr ❑ /��N �
Name W mort9a9ee or oontrarl setler ���
Address of mort9agee w contrad se0er (nurtiber and sLee4 �y. state. a mde) •
Name of assiyiee or other owner rn holder o1 rtwrtgage
Address ot assig�e (num6er aM stree4 dry. s+ate, aM ZlP cotle)
Oces applifant own properry in any aNer If yes, � eauftion Deen repuested on p(aperty
munry in Ind'ana? ❑ Yes ❑ No f � ❑ Yes ❑ No
Drawer \�0....a,.�.�1.........
DeEucGOn aOWw�M'vi Ne amouni W: : r iW D
Caid NO. ....'7� .............
zo 2o zo _� I y 7, ��0,�/ `t�� � M�Co•!o 20
Signahue W Camh AuCitor Counry Date (month. tlaY. Y��1
I/ We certify urWer the penalty of perjury Ihat ihe ahOVe and foregoing infortnation is W e aiM cortecY and that ihe applicant is a resident of Irdiana ard
owner I mntraG Duyer of the afwementioned property on date appliravon is filed.
(owne hAreme) Date (rtmfh. daY.Y��
ent addres d applicant (number and street, tlry, state, and ZfP mQe)
3 S• W �
autlnra �y tluy ezewted Power of AttomeY a bY IC 61.1-12-0.7 Date (monN. day, yea�
Address W aWro�'veA person (numberaM t. riry, s!ale. aiMZlPCOde) .