HomeMy WebLinkAboutMortgage_Hart"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�_,_ FOR DEDUCTION FROM ASSESSED VALUATION
:• Sbte Fartn 03709IR71 / 6-09)
`,�,� � Presaibed 6y DeP�rd at Lnml GovemmeM Finance
File Ma
INSTRUCTIONS: A �
To be filed in person or by mail with Ne CountyAuditor or Counry Recorder ol the oounty where the poperty is bcated.
Fifirg Dates: 1J Real Properry: M�st file durirg the year (or which fhe deducLOn is soughG � Counry Audrtor
2) Mobde / Manufactured Hortres rat assessed as Real Property Must tde during Me hvelve (12) rtanths I''I /�''
6efore Ma/ch 31 of each year the deduclion is soughG aL-1 �l Recordu
Seereversesideforadddionalinst/uctionsandqualifications. GIBSON C NTY A DI R
IP�m (owrer armraraa Dyer -.me resniraons m reverse vee)
i � l. l___ % � �'
�,.�,�
If ro. what ts his 1 Mi exad share ot Nterest7
arllegaldesti 6on
-05 -�a -/OD - caol.
��/ Contraa'udebted�ress u�Pa�d az U
a,�� 60 �
rc ��
If name m remfd is dRemn ttun that of aPP�ant, uMiram
Name of mort4a9� or mntrari
�a
w athrl owner w hdder af mortga9e
W assignee (number eid sfreet
Dces applilant wm property in any oMer
cwnry in Indana? I"1 .,_'
DeEurdon ePP�� �
�
sg�we w c«sn n�
I/W�
owner I mntract �
Sia �'owne/s hR
Remrd wm0er Page �wrtroe�
33-oa � �o� 93�
,�rty�a��� meem�wess ��;a � m � «�rack �
❑ Yes ❑ No
n someofre dher Ihan spouse. Indicate weh wlwm
Is tt�e T�7enY m Cuestian: MrivaYy AsesseO
� Real Pivperty ❑ Amlually Assessed . . .
ciry, sbte, an0 LP code)
�e� .3oZ - � - U
s. what munty7 What Tari`g D'atriti7
COUNN AUDROR
Has Nis d
for artem
m propeny
❑ No
zo zo_ zo_ zo_ Dra�veri\'O.c.?0/0...... ..
�„�ry Card �\`O. c�`���....
penalry of perjury that e above antl foregoing infomiatlon is we end co f��' �/ lp � 60
of Ne aforementioned procertY on date aPd�tion is filed. ' --
tlty, slata, arrd
ezewtea Power o( NtameY rn
Address of auCwraed G�^ (numberantl sbeeR �: stete.
Date (rtmfh. deY.
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