HomeMy WebLinkAboutMortgage_StaggsSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n T ip Year
,. FOR DEDUCTION FROM ASSESSED VALUATION
s� F«m aa�os �Rio ni-0a�
` � �bed by OepaMien� d Lar� GwemmeM Finance
INSTRUCTIONS: Fite Mark
To 6e filed in persm or 6y mad wifh fhe CountyAuditor d the county wheie the propeRy is located.
Flirg Dafes: 1) Real Property: Must 12e dunng the yeer lor which the deduction is sought. �a� ,Q
2) Mobde / Manufecturad Homes not assessed as Real Property: Must file dunng Me lweNe (12J monfhs before (yetch 3�each yeer
thedeductionissought GIBSON COUNTY AUDITOR
�ee reverse side /or a�dional irtsbudions eM qualificat�ns
ft�a�U�ner�r M�va: mro�mse el
� n�r�n t. as�rem
tl ro, wfiaf ¢ hb
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C name on �ecord is d�areM Uun UW of apP�l indimte babw.
Name d mortgapee «mNrect se0er
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fdy, SfdR'� NIE
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(0-3 o�-t� l. �i
unRaid as d Morlgapa / Caitraq
dale of appfimtion
leqal a eQUCaGe ameR
❑ Yes ❑ No
saneoire afhar Uun sG�a, i�Wi�e wiN Wvn
�
� �a mweM � auesfion: nnnuaM assessea
❑ Real P`operty ❑ Mnuallyl�5sessed
Does aDP��I own PoO�Y in airy ofhar tl yes. wha� mu�Y? 1 ---'___ -....„� � D�M
coumyinlM�iana7 UI':11}'CI' �i a/�� /��{ ❑ No
❑ Yes ❑ No O. . . . . :-�v . ! . . . . .. �
COUNTY P 7�
oedudim avcrwed in me amwm or. C;� 1'(� \j O. ....�� /�
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Synalura d Cwmy Autlila // CamN Oate Irtrorith. daY• Y�A
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I/ We certify u a the penalty of ry ihat the above antl foregang mformation is true antl cwred and that the appGcant is a resiAenf of Ind"a� antl
owner I contrati buyer of the aforementioned property on date appliration is fiied. �
Si�afur�(owrersfiIDremele . Oace(mo-Eh.OaY.Y�)
Pe�san aulhar¢ed by duh/ exewled Power o(Atbrtrey a by IC 6-1.7
penan (numborandsUaof,tlty,sbfo.
oate (maan. eay, year)