HomeMy WebLinkAboutMortgage_McConnell (3)"'� STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
.;.-- .
; FOR DEDUCTION FROM ASSESSED VALUA�� ��
saca F«,,, aa�os cRn i soe)
S � ResaiCeC by OepaRmeM of Laral Govemment Fuance
� File Mark
NSTRUCTIONS: AA/�[} ,(�',
To 6e filed in person or 6y mail with fhe CounryAUditor or Counry Recorder of the countyWi��e phipEHy is located. F� ���
Filing Dates: 7) Real P�operty Musf fiIe durng the year for which fha deduUbn is souqht.� unty Auditnr
2) Mobde /Manufedured Hwnes not assessed as Real Property Must fileduring� (12J months
before March 31 0! each year the deduction is sot�ht. c\ ❑ Counry Recordu
Seereverseside/oradditionalinstmclionsandqual�cafions. GIBSONCOl1NTYAI1flIT(1R
Key rnan6er / legal desaipl$n RemN numbrl Page nur.�6e1
a6 /� -foo-oo/ aa sL oa�
Y real poperty as of Mortgage / Contracl "vMe6tetlnes5 unpai0 as of Morigage I ContraU inde6tetlnrss unpaid as d Is Itie appfcant ihe sole
year Mard� 7. airt)i�ysa) p.+�� date of appGtation legal � �
� L! J
Yes No
If ro, whal is llis
If nama m remd iy dllerent Nan Cut�of appli�ant. ifMifate Oebw:
Nama of mwtgagee ar mntrau se�er � J
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aaaress� o-Y»----
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D,��„��- �o........,.
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a ��,a�o�������
m
Deductlon approveA in Ne amount oE
20 20 � [U
I
Sig�uWre d Counry P�uditor
wiM sameorre oCrer tlan sPOUSe. iM¢ate with whan
te, and ZIP code)
�t�/? What Tanng Distnrl?
GOUNTYAUDROR
20 _ 20 _
Counry
Is Me property in puesmn: MnuaM AssesseE
❑ Rea� a'oaertv ❑ nm,ua�y wssessed
Has Na detlucfion been feque5led m P�PP+LY
for cunent yeaR
❑ Yes ❑ NO
2q I 20
I/ We certfy under ihe penatty o( perjury that the aDOVe and foregoing informalion is We and corteG aM that Me applinnt is a resident of IMiana and
owner / contracl buyer of the a(orementioned property on date application is filed.
ol applicant (numberind sLeet, dry, stata, antl ZIP ootle)
�, ��,c ��9�� Q z i��a�� i� Y�� �a
tlWv exenrtetl Power d Attomev w W IC 61.1-12-0 7
P4d255 of author¢ed persa� (num6er aM sbee4 �ry. state. aM ZIP code)
Date (imrch, daY. Yva�
3-i-ia
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