HomeMy WebLinkAboutMortgage_Lamey"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_, = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fam 0.?709 (R71 / 6-09)
\ I Presaibed by DePartmerrt of lacal GoremrtieM Fu�ance
�iSTRUCTIONS:
To be fiied in person w by mail wrth the CounryAUdifof or Counry Recorde� o/the couniy wheie the property is located.
Fifirg Dates: 7 J Real Property: Mus16k durirg the year /or whirh the rleduction is saght. A f
2) Mobde / Manufactured Homes rrot assessed as Real Properly Must fife during the fweNe (72) months
before March 37 of eech year the deduction is sought. C
See 2verse side for additional inshuctiOns aM qualificafions.
1 wiN:
Zwynty Auditnr
�ounN Recorder
qpp6capt(ownerwmnrrac+buyer-seerestrxlionsmreversesde) y . GIBSON COUNTY
Ats�seCV�(�edreal of
MetCh 1, admnt ycz
rc m. wtw� is na r ner e�o� share or interes+?
If name m 2md is dfie�m� Nan that af aPP�'
rUme or rtwngagee «crnvaa se�ier
naaren or nnr�agee «mno-act sPoe�
Name af assignee w oNer owner w halau rn morcgage
S,
r/ 1e9a1 EesaiGtim Recortl numbrt Page numDer
-o - aoo-o 3 4 8-0�/
Mortpage/ Contract inde6teEness unpaitl as of Morigage I ContrsG uMe unpaid eso� Ls the appfiont Me sole
Mamh 1, wrtent year Eate o! aOP�� � D� �. D a ) legal w eqwtade ame(�
� ❑ Yes ❑ No
If awned xiN someo�re oiher than spouu. iMk�e WM whan
bebw
� ��.
Is tt�e ProPe!b.in oues4o2 MunW W Accn«!—.
- Dra���er NO...��.Q.�..
Card 1�'O. .... � �..cJ.. I. ....
AO Of 255gnee (nUm68! aM sIRE4 Clly. sHIC, d/M ZIP cntle) — I I�) �� �
F -.3- � !�./a �
ppes apdiran( pm properry in any aUU If yes. �Mat munty.� What Ta�my Districi?
�������� n Yes ❑ No
U^OG�T1
�
amount of
r ��
Sigrehrte of Co�mty Au0ltor
�-° T. �s�rlvv�
1 I We certify ufWer the pena of pe�ury
owner I contract buyer of ihe a(QremenOc
������,�
� ❑ ves ❑
2p 20 _ 20 20 _ 20
Caunry Date (�. daY. Y��
e above aM foregoing inforrtiation is We and cortect and �hat the applirant is a resident of Indiana ard
�roperty on date appiication is filed. �
Date (rmvh, daY. Yee�
iC n
� Full resident atldr of appfi�nt (numDer and et, dty, sfate, eM Z!P ca
'f`�1o� S �ovw pwe v�/
Puson author¢ed by dWy ezecaRed Power of AliomaY a M IC G7.1-12-0.7
Pddmss ot authoraed person (numDer arM StreeL dry sfate, erM ZIP totle)
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