HomeMy WebLinkAboutMortgage_Davis (12)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�__, : FOR DEDUCTION FROM ASSESSED VALUATION
� State Frortn 93709 (R71 / 6-09)
�' ,.,. � PresaibeU by Department of Local Govemrtrent Fnance
ie a
STRUCTIONS:
To 6e filed in person oi by mail with fhe CounryAud'rtor or Counry RecoNer o7 the county where the poperty is located. � d�� �
Fi7irg Dafes: i) Real Pmperry: Musf file durirg the year for which the deduclion is sought. �_Counry Auditnr
2) Mo6ile /Manufectured Homes rpt assessed as Real Prz�perty Must fi7e dunng the hveNe (12) months C. M�.� ..y
6efore March 31 0( each year the deduction is saqhf. U(\Co ry Recordu
V
See reverse side for additional instructions arM qualfications. G I BSON COU NT Y AUD
MP�Wni(ownerorcontrart6N'ar-seerestri�lionsmreversesdC) %�i
Tazug oistrM Key ruanOrj'/ kYjal Cesrnptpn Record numDer Page number
fc 'I�-dl — Yoo-oo�{.rtb-o�► 2,0�1 ��87
Ases.ed d real as W Abngage / Contract'uMe6tednrss un �iA�$ Mortgage I Contraa indeMedness wpaid as of Is Ne apd�t the sole
Mert3i 1. year Marrh 1, a�rtent yrar� G(f C�gO �(,.p{'C� tlate of aPpGcation legal w epukaWe wvneR
S O ❑ Yes ❑ No
If no, what Is Iris / her eraa slare of interesi? I/ ow�reE w'r,h somcrone olher itan spwse. irdicate with wMm
If name on r¢<prt1 is dillerent Nan ihat of appti�ant, indinte bebw. �is yu�e property in Question: nnnuaiy nssessee
La�� �PenY ❑ MnualyAssessed _
name ot'rotgagce or cmtrarl seuer
S;
ACdress ot mortgag� or mntract se0er (n�ni6er and st
Name of assignee w aher owner or hdder of mortgage
,�a� a�?�".N 7 � �re. e�
Oces aPPlipnt own prope�ty in any oNer �
Deduc6on apprwed'u� Cre amoum of:
20 I 20
Sig�wre d Coimry PLdaor ^�y��^
C •�.�/ V 1
I I We cerUfy ander the penalry of
owner / contracl buyer of the afor
k I �„e. ,�.�r,,, � .ro'�
� FC�'�'�Y O �n
Person auNOrized by Euly ezetute0
P4dress of aulhoraed persan (num
ciry. sbre. arN Z/P code) �Q //
DI'111'G' �'� ...................
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s, what munt�? W�at Tarirg I�� 9S�v. /�c�
No
�Z�I�P, i �'l_l�1 �L Z�T 7
20 20 _ 20 _ 20 20
Counry Date (�mrth. daY• Yea�)
ihe above a foregoing infortnatlon is W e and correU and Mat Ne applipnt is a resident of Indiana and
property o ate application is filed.
. Date (rtanlh. daY Yaa�)
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