HomeMy WebLinkAboutMortgage_Stolzs°"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION �
s�ie F«m aa�oe �as r z-0» �
S y,. 1 PresrnbeC by Departmenl of lad Govemmenl Firwice �
File Mark
iNSrnucnoNS: JUN 9 [Oitj
To be filed in person or by mad wdh Me CountyAuditor o/ the county where the propeRy is located. .
Fding Dates: 7) Real Property: Dunng fhe 12 rtronths be/we June 77 0! the year the dedutGon is to be eReclive.
2) Mobile Homes assessed under IC 67.1-7: Behveen January 15 and March 2 o/the year the deducfion is to be�e.�v
See ieverse side for additional insWctions and qualifications. � ����
v GIBSON COliN7v UDl78lS
Applicant (ga�er�6r mnvact buyes - sqe resLic6ms m rer_ene-adel_ �
Ta�dng
Key mimber/ legal deuriPU �
- Q�• ��-�a-�
3rch 1, aarentyear Mariga9e / ConVad indeWedriess unpaid as of Mamh 1,
curtent year C � � `- R
� 7 UU
remrd is tl'Merent Ihan Ihat of applicant, indimte belav:
Name o( mortga9ee or cantracl
Address of moNgagee or canUati seller�/um6er ar+d sfreel. tity. sfafe, and Z!P co0e)
Name of assignee or Wrer owner w holder of matgage
Address M assgnee (rnuMer ard sfrae; dty, sfafe, and Z!P mtle)
Does applicanl own property in any other If yes, whal county? -�
caunry in Indwre? ;
❑Yes ❑ No
COUN' '
Deduclion approved in the amount of:
20 Q� � 20 'U 9 I 20
Counrylw0ilor
Remrd number
Is Ihe
spause. indicale with whom.
x equitade ownef?
❑Yes � Na
Ihe property in question:
�iFeal Pmvertv ❑ Mobile Harie (IC G7.
Drawer NO:..°.?�....... �„�'�e°v�m
� ❑Yes ❑ No
Card NO. ......R,.� .rJ.�
� 5?, �. �....
20 I "'
Counry
20
I/ We certfy under the penalty of perjury ihat fhe abwe and foregoing infortrwtion is true and mrrect and U�at fhe applicants was / were a resident o(
Indiana and owner of the afwementioned property on March 1, 20
Signature (awners htll name) Da�e (mmfli. day. yea�
by duy
cdy, stafe,
61.
Address af auUmnzed person (num6er aM street aty, state. aM ZIP
OaY Y��