HomeMy WebLinkAboutMortgage_Deputy^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
: FOR DEDUCTION FROM ASSESSED VALUATION
is --.. ' Sfate Form 437091R71 / 6-09)
S I Presaibed b� DeP��n� of Lxal GovernmeM Finance
�lSTRUCTIONS:
To be Red in person w by mail with the CountyAuditor or Counry kecorder o! Ihe county where !he pioperty is located.
FiTmg Dates: 7) Real Properry: Must fi!e dwnmg the year /or which Ne deduction is sought.
2) Mo6de /Manufactured Homes rrot assessed as Real Property: Must file dunng the fwefve (12) months
6efae Maah 31 of exh year Ihe Ceduclion is sough[.
See 2verse side (or additiona/ instrtictions and qualificatipns.
A/a�Ch 1. aarertl yrar
�i 110. W�N� 6 �115 �:ICf
on
-see mreve e e)
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Key nimhel / legal desaipti
- o? /�3 - �O- UOC�. 03��-
f M1bnoage / Contraa IMe6teCness unpab as o( Mortga9e / Cc
Mamh 1, curtent year date o( appOc
euU snara ot inreresC!
Eittuent ihan ihat o( aPW��. ��te bebx-
Name ot mortgagee a mnttact seller � / I
y i��:
Address of �mrnJa9� n contrad se0er (nun end street �Y. S
Name al assignee w oNer owner w hdder at morigage �
Atltlmss of assi9nee (number a� streeC dry, sfate, and ZIP m0e)
If awned with mmeone other Ihan
Year
Fwm t�e0 wilh:
M� 1��9�Pd���
County Recorder
C. .�..
GIBSON COUNTY
Remrd num0er Page numbrl
7
��y ne}��m ad as d Is the appGranl Ne sde
e�� 7//[/ legal w equitade axne(?
❑ Yes ❑ No
>pa+se. i�Wicate wRh �Hirnn
,I-s-,tl(�e property in questim: Mnua�y Assessed
Q� Real RoPenY ❑ �^^��Y �
' \ Mobile lbrtie fIC 61.1-�
�' Y>E /�-� - � � /q�
Dces applimnt own property in any oNer I( yes. wFa! munt/1 NTat Tad� Distr'xY? ��"'� —�-"'
wunty in Indana? ❑ Yes �
❑ No �!:. .
pI•a���er NO..„. . .
� COUNTY AUOROR ' ) _ I ^ ' � � - "
DeEuGbn aPWv+ed 4i Ne amouM of. � Q� J. C�
c�t'ci\o.... .. ��'la%Y�•..
20 _ 20 _ 20 _ 20 _ 20 � ^� y„ ���C�CL�" '
—1 � �u� �
Sig�uture of CamN Auditor Counry ' Date (monN, daY• Yea�)
I/ We cert'rfy urWer Ne penalry oi perjury thai the above ard foregoing information is We and correct arM tha[ the applirant is a resideM of IMiana aM
owner / contracl buyer of the afrnemeMioned properry on date appiication is 51ed.
Signatlu�(ovmeYS fiAI name) i A _�. Dale (rtnnfi. daY. yea�
/// . f/
I FW 2siAent aCCmss of appGCany(number entl sy€et, d4! state, and LP aotle)
�� E 5o s � ue ,� .� y767o
Pason aullro�rzeE Ey duty ezecuted Power of Attomey or by IC 61.1-12-0.7
Addre55otaWro�rsedperson (numberantlsneef,cIIy,5late.arMLPCnde) .
(rtpnN, tlay, yea�