HomeMy WebLinkAboutMortgage_Cornette^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS To p ear
__ _; FOR DEDUCTION FROM ASSESSED VALUATION
sa� �„ a3�os (R�i i sos)
S,,,. f Presvibed M��d or lttal Govemment Finance
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INSTRUCRONS:
To 6e filed in � F� �� ��
person w by maii wiM the CountyAuditor or Counry Recorder o7 the county where the properry is located. v
Fifiig Dates: 7) Real Pmperry: Musf fi!e during the year lor which the deduction is sough[. a �'r,f,'..a�ry q�dimr
2J Mobi/e / Manufadured Homes not assessed as Real Properly Must file dunng Ihe iweNe (72J monfhs 7T �
before Malch 31 o(each yearthe deduction is snught GIBSON O YCUM9Y��
See reverse�.s�'de 7or adtlifional insVucGOns and qualfiratians.
'�. AppGnnt r or oonvart buyer - see m�"wis m reversejjpe) , .�+.
Ta�dng �istririV mber I legal descriDYxn - Record num6er Page numDer
o��-ll-3 -yoo-oo� 7�Y-oa-/ 2�OO �O
A� d mal as d Mortgage / Contraa mdebfe0ness unpaid a of Mortgage / Con�tl'uWebteCnass unpaid as d Is Ihe app�nl Me sde
Mamh 1. ymr Martl� 1. arrent yeer date o( appfuation legal w eduitatle o�mefl
�'� Q (� ❑ Yes ❑ No
Ii ro, what's h's f her erad share af intEresi? If awned wi� snmeane dher Ihan spouse. mdi�te w'tlh wlrom
If name m �ecotd is diRUrrt Ihan Ihat o( aPP��t uMicate belmr. Is the P�PPrtY in Ouestion: MrweAy AssesseC
❑ Real Property ❑ AnnuallyAssessed
MoWle Fiortie IC 61.1-�
Name ot rtnrtgagee a contract se9er �
mntrad seAer (number a�d
of assignre or oihu awner or holder of mortgage
rity, sbte, aM LP code)
(numbar ard ahee; cdy, state, antl LP cade)
Dces applimnt v.m property in any oMer
murM/ in IMatu? ^ _ _
20 I 20
I/ We certHy under �he penalty o(
owner I contracl buyer of the afon
�ranue (owners f�ID req�e) _
20
that the abov a
ned property an
_et. dN s+ate. and
—�_
�
Dr•a�ti�er i\'p,. a00� .
I —1
Cat'Cr l���. ....�:d, /
COUNTY P � I ,I) ulxJ . � . .l �. . . . . . . . .
20
Counry
20 _ � 20
��
,,�,�
20
n0 foregoing infortnalion is W e a`W mrtecl aM U�at Ne appiirant is a resident of Indiana aixl
date appiication is filed.
Date (monfh. EaY• Y�A
Person aultqrtzeE Dy Euty exeateE Power of Attomey or by IC 61.1-72-0.7
Pdtlress of aWiortred person (number arnd sbee4 01'. �te, and LP wtle)
5
;e (monlh, tlaY• Yee�