HomeMy WebLinkAboutMortgage_Paul� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
_ • FOR DEDUCTION FROM ASSESSED VALUATION
� StHe Fom143709IR17 / 609) _
� t PrrsviEed by DepartmeM of local GovemmeM Fu�arce
w.
wsrRUCno,vs:
To 6e filed in person w by mad wifh the CounryAUditw or Counry Recorder o/ fhe counry whele the poperty is located.
Fifirrg Dates: 7) Real Properry: Must file during the year fo� which fhe deduction is sought.
2) Mo6i/e / ManufaUUred Homes not assessed as Real Propelly Must fiie dunng the fweHe (72) months
befo�e Ma/ch 31 0! each year the deduction is sought.
See 2verse side (or additbnal insfiictions and aualifications.
1, wrent yCdr
Ls h'a / tcer erarl share ot interest7
tt name m rernd'a Qdfe2ni lhan Nat d app0�an; Indirate Eelov!
rla�rie ar rrcxtgay„ o. m�axc
d morigage
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GIBSON
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sg�awre orco..�,,..u,wr
�[yr�)Jp{)'ppp�uuuditor
P CounlyRecorder
as of Is Na eppOfant Ne sok
legal w epuitahle ame/t
❑ Yes ❑ No
H owne0 wiM somea�e oCirl than spouse. Indimte with �imm
What Ta�dng Dittrict7
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15 IM poperiy in Vurstiwr. MnuaOy Ass¢sed
❑ Rea� aro�eny ❑ rv,�uanywssesscd
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Date (monM. OaY Y��
m piopeny
❑ No
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I/ We certify urWer the penatty of perjury Mat Ne above arW foregoing informatirn is we and wrrecc arid Nat Ne applicant is a resident of IMiana and
rnmer / cantracY buyer of ihe a(oremerrtioned property on data appliration ic filed.
/o�efs n,o � � oa� (�m. esr, rHenO
/., � � 5�-aG -/
ot appOrant (w/n0er antl s4ee4 �: �te,
Pe�son auNwued �y dtAy ezecuted Power o(Atlomey rn by IC G7.1-12-0.7
per,.on (n�m0er ern0 sbaet �: sbfe, arM LP ootle)