HomeMy WebLinkAboutMortgage_Engels"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[a Form 0.7709 (R71 / 609)
♦ ! Presaibed M DePartmeM of loral GovemmeN Ftance �
wsrRUCnoNS:
To 6e filed in person or by mail wifh [he CounryAud'ROr or Counry RecoNer o/ the county wheie !he property is located.
FiNng Dates: 1) Real Pmperty: Must file dudrg fhe }rear /or which the deduction is sought. f1
2) Mo6de / Manufactumd Homes �rot assessed as Real Property Mus! �ile during the twelve (12) rtwnths+'
6efore March 37 ot each year the deducfion is sought.
See reversa side lor zddifional insUucUons aiM qualifications. `
(owrrerorcontrarl6 r-see re�erseside)
3 �ZQ�nryAUditor
❑ Counry Recorder
Y /�� GIBSON COUN i r
Ta�ong D' ' Key numCer / legal desaiption RemN number
�.��-a�-ioo-oov.iia-ua-� od
AsrsseC d real as o( Abrlaage / Contraa'viCe6tedness unpaid as of Mwigaqe / Conraa'vMe6tedness impaiE a of Is Ne app�rant tlie sde
Mard� 1, amnt year Mamh 7, airtent yeer Cata of applifation legal or epuitade wme(.�
� 'a. Q 'J Q � ❑ Yes ❑ No
II ro. what is his ! her e�ct share of inte.fest? If owned vriN someorie other ihan spouse. ildimte with wMm
If name on iEmrd "s dAferen[ Nan that o( apP�^L mdicate beb�r Is tl�e property in purstion: Mnualty Ass¢ssed
, [�Real PfoPeAY ❑ ArmuallyAssessed
Mohle Flome C E7.1-7
Nartre ot mortgagee ar mntract seller _� `/E�/�
Address of rtartgagee u contratl se�er (number sbee; �y. stata, ard ZIP code) _
m assgnee w omer ownet or nmer rn mor[gaga
MEress of assignee (number artd stree4 �; state,
Dces epplipnt own property In any
counry in Ind'ana? � _ "
rdon apyoVed In ihe amount of.
20 _ 20 _
I/ We certify undQf�e penalry of perjury
owner 1 mntrad �ver of the afaemerrtic
yes, wnat county7
20 _ � 20
��.......
Drawcr NO..... ..
� . Card�O....�•�.........
_ ^w�� 1� �WiU,IJ. � .
;J
W�+�Y
❑ No
2q _ � 20 _ � 20 -
eav. r��
above and foregoing intortnaUOn is true and mrtecl arW Nat Me applipnt is a resident of Indiana aiM
�erty on date applicalion is filed.
. Date (month. daY. Y�h
entl stiee(, ciry, slate, aM ZIP mde)
_.....1..,,. T4J 4167U
Person autMr'¢ed by Ouy executed Power o(MOrney w b� IC G7.7-12-0.) I �ate (mmN, d2Y. Y��
Pddress oi auNn'ved person (number aM sfreet, tity, sra(e, end LP oode) .