HomeMy WebLinkAboutMortgage_Sizemore'°+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co ow Year
,_., , FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 93709 (R71 / 6-W)
�,,,. ° Presaibetl by DepartmeM of Lodl Gwemrtrent Financa
il a
�STRUCTIONS: ,J
6e (ded in FO1� � �'�
person or by mad wi[h the CountyAuditor or Counry Recorder o( fhe counry where the pioperty is located.
Fi7irg Dates: 7) Real Pmperry: Musf fde dunrg the year /or which the deduction is sought. ��� ��(gnty Auditor
2J Mobile / Manufactured Homes rrot assessed as Real Property.� Musf file dunng the tweNe (12J monfhs ❑\\ ��
before March 31 of each year the deduclion is sought. (:aun ecorder
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See reverse side for addifional instnictions arM qualificatbns.
'. Appfj�ant fowner ar contrad Cuyer - see reabjrbons m reverse snYe�
ed vdue d� properiy as W
1. aarent year
If no, what s hs / her eutl sha�e of interest?
recutl is dMerent tlun ihat ol appGran; iMk�a[e Delow.
s�rlr�.r.�
of rtiartgagee or mntrad
Name af assignee w oNer owner or htlder of mortgage
AAtlress of asvgnee (number and stree4 c¢}'. sla(e, and ZIP cotle)
Does appircant oxn property in any other If yes. what munty?
muniy in Ind'ana?
❑ Yes ❑ No
zo � zo � zo
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GIBSO NTY AUDITOR
Q � �� �
I ContraU "vWebiedness unpaitl as d Is Ne apptirant Ne eM°
pGcalion 7 Iegal or equita6le owneR
O/f i0 ❑ Yes ❑ No
orie other Ihan spouse, iMicate vrilh wMm
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What Tau(g D'avirl?
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zo zo
Mnua�YA55e55ed
Real RoPenY ❑
� 0 %b�R�
.�iir�S#on (ji� e`o
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I/ We certify under the penalty of perjury that the above and faegoing in(omiatim is W e and cortec[ aM iha[ ihe applinn[ is a resident <
owner! mntract buyer of the a(we tioned property on date applicatlon is filed.
�nawve (owners hN name) � Dare (monfh, day, yea�
state, and
Psson auNwrzeO by tlily ez¢�uted Power o( Attorney rn by IC Gt.1-12-0.7
AdCress of aulhor¢etl person (number aM sbeet �Y, sbte, aM LP code)