HomeMy WebLinkAboutMortgage_Neibert'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES 7 ip Year
FOR DEDUCTION FROM ASSESSED VALUATION
s�a F� a3�oe �Re � z-0�t
S � rhesa3ea by Depanmsri a Local Gouen,mgn Firance
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Mark
INSTRUCTIONS:
To be filed in person o� by mad wifh the CourttyAuditor of fhe couMy where fhe properfy is located.
Fd'u,g Dates: 1 J Real Hoper(y: Dunng the 12 months belae June 11 0/ the year fhe deduction is to be eAecGv�. ,Q
2) Mobile Hanes assessed under IC bf. f-7: Behveen January 75 and March 2 0) the year the d ucti �to 6e�tive.
See reverse side for additional inswcGons and qualifications. G IBSON COUNTY AUDITOR
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If n.; whal is his / her exaG share of i
If rqme m recad is drffe+enl lhan �ha
Nartre of mrntgagee or cmUacl seller
nddress or nanqagee a cw,traa ael�er (numaer and sbeec �r. srare,
Name af ass9nee a dher wvner a holder of mortgage
Address of
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operty in arry other If yes, whal counry7
❑Yes ❑ No
Deduction approved in Ne amoun
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i I We cq �ry under t
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app6pnl lhe sde legal a eqiritade owrieR
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If owned wGh sameone lJ •� l
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COUNTYAUDROR
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pe�sm (number arM s6ee4 mY, state.
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foregoing infomiation is true and corred and thal the apptinnts was / were a resident of
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Date (rtmfh. daY. Y�/)
Date (mmN. QaY• Y��)