HomeMy WebLinkAboutMortgage_Scott^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
�• Sfa[e Fortn 93709 (R11 / 6-09)
1,,,, l Presaibetl by DepartmeM of L.oml Govemrtrent Fremx
Fil
NSTRUCTIONS: F� fl� �:
To 6e filed in person w by mail with the CountyAuditor or Counry Recorder o/ the county whele the property is bcated. gp f
Fiting Dates: 1J Real Pmperty Must file dudng the yea� for which tha tletluction is soughL � C�[ppLhry quditnr
2) Mo6de / Manulactumd Homes not assessed as Real PropeAy: Must file during the fweNe (12J monfhs
6efire March 31 0( eech year the deducfion is so'ight. C unty Recordu
See reverse side !or additional instnictions arM qualifications.
.Wp5cani(owreracono-acr uyer-seerewirbonsmreverse � e ,, GIBSON COUNTY AUDITOR
o�
7ap�WDistria Ke rniimbu/legaldesaiptirn RemNrumber Pagenumber
��
his / her eYaU shara o( iNerest?
m�cmtl is &Rurm than Uat of aDD��t irM&ate 6ebw.
Nartre M mort9a8ee m m�traG seller
aearess d rtiortgayee or rmo-aa sen
mortgage
- 300 - oo/. 5�� -o �/ 3 �
; iMe6tedrress unpaid az W Mortgage / Cmva�Y mtleMedness unpaid as of b ihe apq'rcant Ue sole
ar date o( appGCation legal a epuitade orwme(?
� Q ❑ Yes ❑ No
H owned vriN someone other than sW�, irWMate wNh wlam
Is IM Property in VuesCUC MfwaDy Assessed
I`�� �PeKY ❑ �Y �
Moblle Fiptle IC 61.1-i
sta.e,
AC 255 of asagnee (mxnber anC snee4 �y, sbfe. antl ZIP cotle)
T sw a-.3- l, as � �.
Does apyircant wm popem/ �^ any othx It yes. what munry?
courdy in Ind'a�? ❑ Yes ❑ Na
Detluceon apppv¢d'm tice amouN
�_ � �
SignaMe o(
COUNTYAUDROR
!_ � — �t
Dra�ver NO..
�.�.l.l...
Card 1\TO. , ,
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20 � 2a — � 20 —
Counry
Pl���.q
I I We certify under Ne pen�iy o( peryury that e above antl foregoing infortnalion is true and correa aM that Ne applipn[ is a resideM of IrWiana and
owner / mntracl buyer of the aforemention property on date application is filed.
Sigqa re(a h fiA me) Date (month. daY. Nea�
` . �� / � Q .
X
Full resident aCtlres d ap t numDer andstreet, dry, stata, ana ZfP ootle)
5'io s Bsa.J G�,�e, le sJ ���
Person auNU'¢EO by tluFj ezetuted Power W AnomeY ��' IC G7.1-12-0.7 �� (//��. daY Y'��
aWVaed person (numberaMSaee4 ary. sbfe.