HomeMy WebLinkAboutMortgage_Winterheimer"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
. .. �' Sfate Fam G3709 (R71 / 609) F
`,.,. f P�rsaiCed by DepartrteM of Lnml GovemrtreN F�ance
File Mark `�
wsrnucnoNS:
F
To be (led in person w by mail with the County Audifor or Counry Rernrder o/ Ne wunty where the property is located.
FiNng Dates: 1 J Real Property: Must file during Ne year /or which the deducUon is sought � �unry Auditor
2) Mo6ile / ManWactured Homes irot assessed as Real Pruperty: Must h7e dunng tha tweNe (12) months '���,p� "
6efore March 31 of each year the deduction is snught � r�ry+a � er
see reverse s;de ioradaniona� instruu6ons and qua�i�icar;ons. GIBSON COUNqv nubiTOq
AOP�7i�'� ar jonvacf Dyyerysqe m_wiraons m/Gve+se sida) _ � , o
Key number / legal desaiVtbn M I '/� (� /�V / PU/ �% D�
O� V<+ :` CJ
i real qoperty as d / Mort9a9e / Contract iMebtetlness unPaid as W Mongage / Contract trNebteE�ress unDaid as of Is Ihe aOC�� Me sole
year Mamh 1, artent year tlate o( appGtatmn n legal w equdaHe ameR
�y�� � ❑ Yes ❑ No
name m 2md is N7e2nt than Ihai of aoo0ranl Nditate 6ebw.
Nama W rrott�a9ea or conttaU u9er
Atldress W mortgagee «contraG seAer (nwMer end shee4 ��i: s7a.e, aM
Name of assignee w mlw owner or hdtler at rtqrtgage
AAtlress ot assignee (n�mber and street tlry, stete, and
Dces ePplimn[ rn�n property in any oNer
tounrymin0'ana? ❑ Yes ❑ No
DeEuctlon aPG�ved in Ihe amount oE
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Signature o( Counry Auditur
�
sonieorie other than spouie, iridicate witt� whom
If yes. what munt�!+ I Whal Taritg Distrirll
— DI"811'CI" �'�....��!�......
z° Ca rd N O. ...�1 � 6 `k�.. . . . . .
- � ��1�, � O . �j
6 tM praperty in Cu�tian: MnuaM Assesse0
❑ Real PfOPenY ❑ ���Y�
n�oa� rt� nc s
Has N's tledurflm Eeen reGUested m P�Y
ror wrm.�a yean
❑ Yes ❑ No
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�� �,�. �Y ,��
I I We certfy under Ne penalry of perjury that the above arW (oregoing infortnalion is W e and mrtect and that the applinnl is a resident of Indiara and
owner I contract buyer of the aforementioned Property on date appliration is filed.
adtlrass ot appfrcant (number antl sfree( cit}; slate, and Z/P
M
m
Date (rtw�M, daY. Y��)
Ia - 1� _
- � Date (monN. OaY.
auUOr¢ed person (number aiM sLee; ciry, stale, and LP code) . I �