HomeMy WebLinkAboutMortgage_CardinalSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownshi Year
_ 2 = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 93709 (Ri1 / 6-W)
� Prewibetl M DePartmeM o( Ln�al Govemrtrenl Frence
�� �� File Mark
STRUCTIONS:
NOV Fa � , ,„:
To be filed in person or by mail with the CountyAuditor or Counry Recorder of the county where the pmperry is located.
Fi7ag Dates: 7) Real Pmperty: Must file dunng fhe year /or which lhe deduction is soughG C.'�. Counry Auditw
2) MobBe / Manufactured Homes not assessed as Real Property Must Ae dunrg the nvelve (12) ma�Ms
before March 37 0/ each year the deduclion is sought. . ounty Recorder
See reverse side /or additional insfructions and qualifications. GIBSON CO
Appfr�i (oimer a conUaU 6uyer- s� rest '' r s ar leverse sid�n � �J
� 1, ar�ent year
�I no, what's ha / her exact 5hare of i
If name on iemtl s Wfrlent Nan tha
r�� o� �� «�� ���
KeY nunbet / legal EeStriVUOn RemrE numbb Page twmbu
a� � 18- a 5- oo- ooa. oos- o� s— �.o � 1 849
Mp��p¢ / Cantratl Bitlebtedr�s unpaid as ot Mortgage / CmtrarY mdehtedness unpaid as d Is Cie appliiant IFre sde
AW�d i, airtem year tlate of aGP���+ �1 « eWitable owrmll
� 3 ❑ Yes ❑ No
terest? tt owned wiN swneone ofher than spousa, iMicate wNh whom
of app6pnL uNicate Celaw: Is IM property in Question: Mm�aP/ Assessed
�a� a�aenr O !�,;,�Ma�a . .
S
Pddress of mortgagee w contrad seller (num6ar and stiee; city, te, arN ZIP code)
Name o� assgnee w oater awner or �ver a� nnngaga
20
ot a59gnce (num6e� a�M SfR¢; [Qy, slate, anO [IY codB) �
� �,, 5- ID.IS6 A
>limnt own property in any oUer It yes. whal wuny? VJAat Ta�dng D'atriU�
ilnaana? ❑ Yes ❑ No
approred'm tlu amount of:
20 _ � 20
I/ We cert'rfy under ihe penal
owner I mntracl buyer of Ne
n,-�„��t-,.ro.... a0�.�.....
C:il'C� l�r�. ....�.�../......
20 � 20 � 20
Date (rrionth. day, yea�
20
above and foregoing infortna�on is true and correct a� ihat Ne applitant is a resident of InEiana arM
�erty�$n date application is filed.
y(y(r�i�frR ad� d applicarit (number and sbeet, ciry, state, and ZIP�
��y�"�-✓• 9oc S, f"�rz $ri,.�
Persan auNa�d by d�dy execuced Porer d AttomeY a bY IC Gt.1-121
(num6er and s�eef, ciry. sfafe, eM LP mde)
6 L�
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