HomeMy WebLinkAboutMortgage_Hicks (3)^y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T ip vear
FOR DEDUCTION FROM ASSESSED VALUATION �
sr� w�,� aa�oe tR,i i s-w�
, y,. PresaibeE ty DepaRrtierG of Loral Gavemrt�eN Frence
File Mark
wsrRUCnoNS: NOV 3
Fortn filed wtrh:
To be fiied in person or by mail with the CounlyAuditol or Counry Recorder of the counry where the property is located.
Fitiny Dates: 1) Real Pioperty: Must fde durng the year /or which !he deduction is soughL � Counry AuEitnr
2) Mo6ile / ManWactumd Homes rat assessed as Real Pioperty: Must file dunng Ihe fweNe (12) � /�'�
6efora March 37 of each year the deduclion is saght �� vC[-� �^A' R��
SeereversesideforadtlitionelinsLUCfbnsarMqualr(xations. GIBSON COUN
App�t (owner nconlrau nuyr� - aee r�ryt mrevers9 side�
T� 9 Istrict . I(ey �uxnber / IeBal desa�tmn Rem�i numEer Page n�m�0�
`�:�inc� - -l3 -2oo-000.���- o�s- ao�o �so�
A�esed vahre rd mal qoperty as d a / Contract Ud�tedness unPaid as of Mongage / Contraa irMebtedness unOaN as d Is ihe a00rrant ihe sde
�,.�� ���°� �M 6 3 ��o���«, '�' o Y� a
If m. what R lus I her axaa share Of intemt? tt wmeO wiN sortieme dher ihan spouse. indimte wtth whom
tt nartie m remrtl's tltlfrient Nan tliac a1 appBmnt, 6Wka9e Debw: Is Ne P�O�Y in 7uesGm: Mm�aDy Assessed
❑ Rea� PmpertY Q ArmuailY Asseaed .._
Name o( mortgs9e� v
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Dces aP� am propeny in a�ry oNer
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I I We certify u er ihe penatty of
owner I con t buyer af the aton
re(owne h6�me)�
r ent add`cs. U eppGCant (numbe
S3 � c.a G, s71 �
Person autlpraeE Cy tluy ncearted Por
AddressotaWwmeOperson (numbera
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�u and sbeaL rdy, s�.e. aM ZIP cadej
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GOUNTYAUDROR
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�u t the above and foregoing intormatlon is We �
�ntloned Property on date application is filed.
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'Attomey w by IC 61.1-12-07
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