HomeMy WebLinkAboutMortgage_Koch^•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATI� �� �
�• State Fa�m 43709 (R71 / 609)
�` ,�w p�¢saibed yy p¢parirtcenl 01 Local Govemmen� Fnance
File Mark
�STRUCTIONS:
7 Fwm t�ed with:
To be ned in person w by mail wifh Ne CountyAudito! or Counry Recorder o/ the county tlle pro�is located.
Ffig Dates: 1J Real PropeRy: Must !le durrrn� the year for which the deduclion is soughf. � County Auditnr
2) Mo6de /ManufacNred Homes lrot assessed as Real Pioperty Must file du (72) months Counry Reoorder
before Ma�ch 31 of each year the deduction is sought.
See2versesideloraddition�l-ipslructionsarMquali�cations. GIBSON CO��tiTV ��,..�_.._ .
ASt�etl vdue aC 2a1 p�M1Y �\
Meich 1, ament'/ear V `%
If ro_ what � his ! hu esa�1 shafe of infere5l?
/ legal Eescription � Record number Pa numbu
-3a- co _9 3 2o i a- ��so
,tortpag¢ Cqntra e6tedness unpaid as of Mortgage / Contrul mdebteCness u�pxid es d Is Ne apyuant the sde
Aarch 1, artent�� O O� tlate of epP��� legal or eQURaWe ovme(1
❑ Yes ❑ No
If wme0 vriN someone oiher Ihan spouse, iMirate v.ith whom
m remC iy 6Rerent Nan ihat of appOran4 triLicate belmv
a��
— pddres c{ �gygce w�ontract se�er (number and streeC cdy. sfate, aM ZIP cade)
/3/,y�3•W
Dra�ver NO..°.�.� /2,-
�,ard NO. ..... �a�......
� umucom� �povev m ure artiwn� rn:
20_ � 2�—
�,
what counl/� NTaI Tadng Distrvi?
COUNTYAUDROR
Zp _ 20 _ 20 _
I/ We certify urnfer the penalry of perjury that kde ahove s
owner / contract buyer of the aforemenlioned property on
and shee4 tlry, state, aM LP mtle)
� ol Atwmev w W IC Gt.1.t2-0J
perspn (number aid slree4 ciN. state, arM
Is Me ProG�Y in Question: Miu+
❑ Real Pmpetty ❑ �le
�, ���� �, �
❑ Y25 ❑ �
20_ I 2�_
I Counry I oate (monN. tlaY�4Q _ �r-�
(��—�� � � 0�
infortnalion is We and comect and that the appliqnt is a resident of IMiana arW
ion is filed.
Daie (monfi. daY. YseA
�Y. Y��