HomeMy WebLinkAboutMortgage_Wilzbacher (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_, ; FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fwm 93709 (R11 / 609)
�' ,,,, � a�esaieea M�Perbneb o( L�I Govemment Fuiance
File Mark
INSTRUCTIONS: AUG 2 S ��_
To 6e filed in person a by mail wi(h the CountyAuditw or Counry Recoider of Ihe county whe2 the property is locafed.
FiNng Dates: 7) Real PropeRy: Must file dunng Lre year for which the detluction is sought. Counry Auditor
2J Mo6Ae / Manulacfured Homes rwt assessed as Real Property Must fiie dunng fhe M1vefve (72)-�r�fhs
befo�e March 37 ot each year Ne deduUion is sought. Q�/ti� �^b R��
Seereversaside7oradditionalins7ructFonsarrdq li� tions. GIBSON COUNTY AUDITOR
Appficani(ownera �-see sid
T "�`�'�i -�'6 aoo-ooa i ��-oa `��� P3��s�
�2hie aE real pioperty as of Abr�gage/ Contra������tttpppdddeeebtedn¢s unpaid as ot Mortgage / Contraa mEe6tedness unpaid as of Is Ne appOcsnt Ne sde
I1leirh .anrntynr Mamhl.arten�OOO� aateofapplicaUon �a' QYeseQ No
�, If no. what is his I her euct share at interesi? �f awned wiM someorre ofher W n spouse. iMkate with whom
If name on 2mN is Eitferent than Nat of aPP��l h�dicate Delavr
mwt9agee or
G tr-�1Ti
ciry, stete, aM ZIP code)
.DI"1\1'CI' �0..�0.�.........
. � � 3.y�;.9�
C:11'(1 �0 . ..:.... ...........
� 1001 �00• C�i
� I p
COUNTYAUDROR
zo _ � zo
Is Ne properry in 9���: /��+aP/ Assesse0
❑ Real RoPertY ❑ Armualiy Assessed
Has N4 tledurdm Ecen requested m proprJty
rw a,�n yPan ❑ ves
❑ No
zo _ � 20
I A A/Yf\\ J I`�NJ I�n, / �' e�C� ` I oate (monty.,tl�yyEasy� ��
1NM �/� l.i�
nder penally of perj that the above and foregoing infortnalion is We and cortect a(M that the appli�ant is a resident of IrWiana arxl
d buy t the aforeme " ed property on date applicatlon is filed.
NII reme) 'l A .� � Date (montlt, daY. Y��
N
ezecutetl Power of Atlomey or Oy IC 61.142-07
AEaress o1 aulha'ved person (number arM sLeet. �y, sYdle,
7 3
>nn, ear. r��