HomeMy WebLinkAboutMortgage_Pullum^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__._ - FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Fortn 43709IR71 / G09)
S ! Prpsoibetl hy �epartment of LDttl Govemment FilNnce
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wsrnucnoNS: F� �� �
To be filed in person or by mail wiM the CountyAuditor or Counry Recorder o! fhe counry where !he pmperty is Ioc�{y�1
Fiiirg Dates: 7) Real Pioperty: Must fi!e during the year for which fhe deducfion is sought. �1 V�`� 2 Z 0� Counry Auditw
2J Mo6de / ManufecNred Homes rat assessed as Real Property Must file dunng the lwelve (72) rtwnths
6efo2 March 37 0( each year the deduction is srought. C � ❑ Caunty Recorder
See reverse side foi addilional insfructbns arM quali cations.
Appfuan�( rn�vact6uyer-seeres�riceqnsm side'� GIBSON COUNTY AUDITOR
C/.
Ta Oistrkf Keymm�6er/IegaldesaiGtion RemNnumDer Pa9enumDer
a - -3� - o -ooa.loa -o�Y /a a 9-�
value d� Waperty as d Mortpa e/ Contraa'uWebtetl�ss unpaid as of Mortgage / Contraa uMebtedness unpaitl as d Is the appfimnt the sde
1, qmenc ypr Ma2h g, airrent yeer tlate of app0ation legal w eQuBade awne!!
I( ro. w11816 hl5 / h¢f ¢IiG Sh2fE 01
If riartia df Rewd 6 dAtgml Wn ih
rtICK3@ hf�OW.
Iartre of rtartc�a9� or mnbacl seller �/�
Address of rrort9a9ce m m�traG seAer (nwn6er and stree4 �Y. sfate. aM:
Name o( assi9nee w other owner w hdEer of mortgage
MCress ot as49nce (number aM atree4 tlry, state, and cod�
�
Dces ePplicant wm ryoperty in any oiher IF yes, what muntyl
counry in Ind'ena? ❑ Yes ❑ No
pion appiove0 c� ihe amoum ot
20 _ 20 _ 20
� -
I/ We certify u�er the penalry M pe�ury t[he ahove
owner I contrad buyer oT the a(wementioned property a
Person autlror¢ed by
(number arM street, ciry, slate. entl
20
I�( O D D O ❑ v� ❑ No
someore oth� tttan spouse. iMim[e with whom
�IS p12 . OPCfIY YI QUCSbOIt: iV1f1U8� pSSC55Ed
2eal P(operty ❑ AnnUally As5e55ed
Mohfle Hame fIC 67.1-7'
a �� 8.S
What Ta�drg DistrictT Has�a dNueim �^^- — �
�UU..U�'r` A�G�Z�
! AUDITOR
�� —daa3
20
�regoing infortna6on is true and a
appliption is filed. •
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Dam (mwth. daY. Yaa�
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