HomeMy WebLinkAboutMortgage_Schmits (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ � FOR DEDUCTION FROM ASSESSED VALUATION
..• State Form 63709 (R11 / 6-09)
S f PrPSrnDed by �epanrt�em oi Loml GovemnreM Fu�ance
INSTRUCTIONS:
To be filed in person or by mail wiN the County Auditor or Counry Recorder o1 the counry whele the property is located.
Filirg Dates: 7) Real Pmperty: Must file dunrg the }rearlor which the deduction is sough[
2) Mo6ile / Manulactured Homes rwt assessed as Real Pruperty Must file dunng tAe nveHe (72J monfhs
6efo�a March 37 0/ each year the deduction is sought. -
See reverse side 7or adtlilional instruct'nns and ualificafions.
AppGCant o mgvartgtp�er-seere ' rgyer�2slde)
Key nimbu
n ro, what rs Ns ! Icer e�aU slure o1 InNfesl?
if name m �emrd'a drtfereni Nan Nat ol app6ran4 induate bebw
Name of rtnRgagee or mntraG seqer
Ad�ress of mortgagce or contraC u0er
Name of assignee w otAer owner or hd
Does applirant am property in any oNer
munry in InCana? ❑ Yes
DeLUCSrn approved in ttre amoum
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T
(�o��ditw
County Recorder
� GIBSON COUNTY AUDITOR
p�o�(N V�( • 7 UO "lA�� RemrCnu V!� P�e /�J/
�
�e6tedncs unpaid as of Mongage I ContraG inCebteCness unpaid as d Is tlie epd�� we sde
/ oO^ datc af aPP�� � ❑ �
�Y U Yes
tl owned vriN snneorre other Nan spouu. indinte wrth whom
Is Me property in Question: MnuaOy Ase� M
❑ Real ProPertY ❑ Armually Assessed .
ier antl svee4 t�N. state.
rtqrigage
5/8te, and ZIP oode) �
If y�. wha[.
No
I 2(1
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Dla��'Cl �
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Catid\�• •�c�p�00�.
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Fi�7
'on Oeen reGUested m pmputy
❑ Yes ❑ No
2(1
� f AWifOr Caun Da�e( `/ / yrea��� /
I I We certfy under natty of perjury at the ahove and foregoing infortnalion is We and correct and Nat Ne appiinnt is a resident of IrWiana arW
owner I conVact bu of the aforemenlioned property on date appliration is filed.
�`aNre (owrelsAAl rtamal . . Date (ma+N. daY• Y��)
ot appfzant (numn6er aM sLeef, dry, slate, a [�N ca
�� S
duy esewted Power o(Attomey rn by IC 61.1-12-0.7
I person (number aM street. �}; state. antl LP coOeJ
(monlh.OaY• yea�