HomeMy WebLinkAboutMortgage_Hicks^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vea
__ s FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 93709 (R71 / 6-09)
, / P�esci0e0 M�nt of Loral GwemmeN Firence
� ile
�JSTRUCTIONS:
afm
To 6e filed in person w by mail wifh the CountyAuditor or Counry Recorder o! the county where the property is located.
Filing Dates: 1 J Real Properry: Must file durirg the yearlor which the deduction is soughL N V 6eq�ty quditor
2J Mo6ile / ManWacNred Homes rrot assessed as Real Pruperty Must file during the twelve (72� months L u
betae March 37 0! each year Ne deduction is soughG Counry Recorder
C
See reverse side /or additional instruUions and qualificatbns.
l�ppGtant(o'�f oroon+� ¢uyer-se�g ' ' reve+seside)� OOn
l.i n n P� � K d / n .. GIBSON COUNTY AUDITOR
Mard� 7, amen[ year I marcn i. a�rtent yeer
�( fq. W�18� 6 �16 � �12f BNdG 5�12R Of I(1{PRSI�
It name m �emrd s dfierrnt tlan ihat W aDP��I Nd'uate bebw.
Name of nMgagee a mntrad sWer �
� /ifl/7
Address W rtnrtga9ce or cmtrad seAer (numbu end sbee4 tity, s7efe. e
Name of assignee or other ovmer or hdE�
Adtlress ot assiy�ee (numbei aM streeG
Does appti�m oxn propsty in a�ry other
munry in IMiana?
❑ Yes
the amaum of.
s'are, ena tir coae)
ir,�s. wt�ac wunry�
�
R¢rnN m�mber Page umber
� �G �3' -a O/
unpaid as of Mwtga9e I Con7aR uitleMedness u� id az d h tl�e app uant Me sde
Eate o( appGCatim �gal a eWitade ox+ieR
❑ Yes ❑ No
It awied v,iM someona Uher Ihan spouse. indrczte with wlnm
Is tlie propnrty in Question: Mnua�y Assesv.d
�M ❑ �N �
Moble Flome (IC 61.1-7
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µ� �MS�at� �
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a
AUDf`
W
20 20 20 20 _ 20 _ 20 _ 20 _
yianne o( Camb Md'¢or Counry Da�e (r+�ortth. daY. Y��
I I We certify under the penalry of perjury U�at the above arW foregoing infortnalion is We and cortecl ard that the applinnt is a resitlent of Irdiana aM
owner ntract buyer o( Ne aforementioned property on date appliration is filed.
»a�e lo /s hAns'nel /I . Y) Date (morrth. deY•Yaa�)
aTJ
/ p � /�[/- v v �
PeF.,an auUniaed Cy duh/ exewted Power W AvomeY � M IC 61.1-12�.7 �� (�^�. �Y. Y��)
P-0dmss d aWrot'ved persm (numbera�M sbee; riry, slate. andLPCOde) .