HomeMy WebLinkAboutMortgage_Miller (6)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Farm 43709 (R70 /17J18)
\ / Prewibed by Oeparlmen� W Lor� GovemmaM Fi(unm
INSTRUC710NS: �UL �8 V [U09
To be filed in person w 6y mad wiN fhe County Auditar d the county wfrere the poperty is located.
F7mg Defes: 1J Rea/ Ptoperty: Musf fde dwing the yeai /or wAich the deducFion is saught.
2) Mobde / Manu/actured Homes not assesseG as Reel Property: Musl fde tlunng fhe tweNe (12J monfhs 68fp�9iMa�cA�pj"each year
fhe deduction is soughL O'� � ��V
SeereversesideforaddRbnalirtshudinnsendqualificaGOns GIBSON COUNTY AUDITOR
Aoo&antfoxn�ormrC2ctbuva-seo mlevtsmsi�l �
Distria
tl reme on iBmd "4 dLlBrenl than lhal
N3T0 � f11C(ilJ2 jB8 C! CIX1�1aC� $B�B!
�'�(o ' pp ' DOO.OG(a -oa'� ��n00 3 ml 8
Cmiratl odablednea unpaid as d Mortpa{q / ContraU inOehtatlnass unPaid as of Is �he aGP� Pia sde
�rteMyaar dateo(appf�tion lepaloreQUdableowre(!
� ❑ Yes ❑ No
N owned with someone alher Uvn sPd+'�. rtdic�e wilh wtnn
3�W' �5 UIB pfOpBf�lfl QIIBS�1fNl: iVllllldq i�55BS'HI�
r�o_-..__ — .�'. '. �
nddres: or nwyagw «wniraa seem (mmae.and sGaot �: slafa
Oaes aPO�^t own aopar�/ in arry other
ooumy in IMareT
❑ Yes ❑ No
anwunt
zo I zo
tl Yes. wtat oouNy? I What Ta
couNTr nuorro
Zo zo
DI"a\\'Cl'
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I/ We certify untler t penalry of perjury ihat�Se above and fwegang u�fortnation is We a�W carect and ihat the appGwnt is a resiEent of Indana and
owner 1 cont2d r of U�e afore�nentioned {xoperty on date applrcation is filed.
Signa/ture ( fiI name) Data (rnmtlt tlay, year)
(.
Full rasident add d app nt (nunbe� eM sber,7, cify s6tr�. and LP oode)
�509 � �brrrit%n � /iau(ZS�z�i�, S'V 9�6� "
Persm a�tharzeC by Euy exeaneC Power d Anortrey w IC 6-1.7-12-0.7 Data (�. �Y• Y�)
person (numeorantlsheaf,dty,state,