HomeMy WebLinkAboutMortgage_Collins (5)^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ .± FOR DEDUCTION FROM ASSESSED VALUATION
� • Sfate Fortn 43709 (R71 / 6-09)
�` � Pr¢soiEed 6y Oepartmenl of Local Govemment Firence
�� File Mark
INSTRUCTIONS: A
a
To 6e filed in person w by mail with the CounlyAuditw or County Recorder of the wunty whe�a the property is located. �
Filirg Dates: 1) Real Property: Must fde dum1g fhe year (or whirh the deduction is soughG C nry Auditor
2) Mo6r7e / Manufectured Homes iwt assessed as Real Property Must file during the M1veNe (72) months ❑
before March 31 of each year [he deduclion is sought. Recorder
See �everse side foradditronal instructions and qualifirations. GIBSON
amrranilewncrarmntraC6rne�-see mh�arses"el i An �
p�ar•r�-^ac—
rc �o, wnai �s r� i n� �a
�,
�,a,�������
or �wnr��e «mnaau seoe�
Mdress of morteJa9rx w contrad se
Name of assignee or other m�+ier ur
AECress
stree4 �y. sbfi, and ZIP mtle)
6�ant ovm properry in any oNer
Indiana? ❑ Yes ❑
oeeuction approvea m me
20
Sigruture W Co�mbAWiiOr
20
-ioo -�o�./ai- �a� ���G,
rdebte�nesa unoaid az of Mwtoaae / Convaa intlebtedness unoaid as
ynar aare or aDP�� /
r, � . '
u�,ea�;m���— � , g • �IC�'J:
_ � ���'°����
r - .
ate. ard Z/P code) �� � '� —
If yes. xfial countyt I Wha� Ta�ting Oistric!'l
COUNTYAUDROR
20 20 20
Counry
for arrent yeah
2q
��
'�snt Ne mle
itade awneY�
� n No
�
�
.�,.
requested m praperty
❑ Yes ❑
�
I I We certrfy under the penalry of perjury that the above arW foregoing infortnalion is We and cortect arM that the applinn[ is a resident of IrMiaria aM
owner I mntracl buyer of ihe aforementioned property an date applicatlon is filed.
iriawre fow�erY hAl namel n � Date (month. daY. IEaA
�
� FW12sident aAdress of a i i er 0 street ciry, st
Pe�son auNOirzetl Gy duy exeaRed Power of Attorney or
Pdtlress of aWroraed persrn (num6erarM sveet, aTy. state.
(mnnth. daY. Y�/)