HomeMy WebLinkAboutMortgage_Dyer (3).� °°� STATEMENT OF MORTGAGE OR CONTRACT INDI
FOR DEDUCTION FROM ASSESSED VALUATION
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INSTRUCTIONS:
To be filed in person orbymail with the CouNyAudiior o/ the courrty where the property is located. MAR � 4 2��9
Fding Dates: 1J Real Pioperty: Dunng fhe 72 monMs befare June 71 0/ Ne year fhe deducGOn is to be e/fective.
2) Mobile Homes assessed'mder /C 67.7-7: Behveen Jenuary 75 and March 2 of the year the deduc6m is to be eBective.
See 2verses�de for addifbnal ins6uctions end qualifications. �j �,�
MWicant (owr�r w mnfrad 6vyer - see
Pssesaed rdue ot re� popaty as
w�en� Ymr MwIBa9e I (
aineM year
I�t is his ! her ezecl share ot inteiest?
If reme m recutl is diBerent Ihan Ihal of appicem, iMmte belo.r.
Name af mortgagee or cmtract seller b�� �
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qtldress ot mo�gagee u mnUad seller (num6ef and sheeG dty, sfal�. and
Name of ass9nee ar alher an� a hdder a( morigaga
Address of=asvgnee (rwn6eraM�• ._.. - -
Does a�. ^ .i`-� `i ' _ � J ?
courLLy u �
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DetlWioi _`7 9 OG
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20 _., I 20
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GIBSON
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intlebtedness unpaiE as of March 1.
sortieane dhar Ihan spouse, indicate wiU whom.
What Te�dng Distric
COUNTYAUDROR
20 20
C�rtY
o. eaN�ae �n
❑Yes ❑No
Is the propeM1y in Queslion:
❑ Real ProceM ❑ Mobile Harie
requesled on poperty
❑ Yes ❑ No
2� 20
Date (�(h. Day, yea�
I/ We certify under the penally ot perjury tliat Ne above and foregoing infom�ation is We and correct and thal fhe applicants was / were a resident of
Indiana and owner of fhe aforementioned property on March 7, 20
FW resideCn.�t address of applimM (nurt�6er a/nd street cd.y/. jstate. and ZIP ca0e
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Person aufhorized bY duN ��� Power al Attomey or by IC 61.1-12-.07
AdNess M aulhwaed persm (numbe� arrd s6eet, cdy. stata, aM LP wde)
Dale (manlh. daY. Y��I
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