HomeMy WebLinkAboutMortgage_Willis (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ur sh vear
FOR DEDUCTION FROM ASSESSED VALUATION �
s�a For,�, aa�o9 �Rio m oe�
` � Presmbed by DapaNnent cf Lod GwernmaM Finar�
INS7RUCT10NS: File Mark
To be fded in person or by med wiR+ fhe CoteNyAtditor d the county where the poperty is bceted. `-7�� //
A"vg Dales: 1J Real Properfy: Must fde tlur'vrg fhe yen� lor wAich Ne deduction is soughG (/'/6�++ N�,�/Ir�
2J Mo6ile/MarnAacWlatl Homes nW essesse0 as Real Pmperty: Must fife dunrg fhe tweNe (12) monfhs 6e�arch 3Y�y ar
thedeductionissought GIBSON COUNTY AUU�a
See reverae side Iw edd'6ronal insWCtions and quel'A'ications
AppGcam (9.fi�r m mreract dryw- see iestrjAians a+ mv�r se �)_' •
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wssessm � a drma� aoc �� d Abtpap a� coreretl ineac
Ma� 1. N Y� Mar� 1. wfrerit Yea� /
E
tl(q. wtat a hq / her euq shara d iMeRSt7
C reme on remrtl is d�eram Ihan that of appfraN,'vidimte helar.
Narne d mo�t9a9� w mn�racl seDer ,
ar WNrad SeOer (rvm6erand slmeL dly.
Narne d assigrree w oiher wner ar hddar d croM1gapa
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Does aVP��I own PoOanY in am� ol
cwrdy in IMia�?
❑ Yes
DeEucton a07roved in Iha amounl ot.
sb�. anOLPOOCe)
Cyes. rhaf muMy?
� No
20 �l � 20 _ � 20
Sgn�ure d
- � d9�� Cc,
= oo� � s 8-va�/ R�-o0 4 a3a.�
paiA as d Matpape / Contraq indebteGness unpaiE as d Is Ihe apqicaM the sde
dafa a( appfimtion legal ar eQu3abla wmeR
) O ❑ ves ❑ No
H a�ned with someorre athar �han spouse. inCiwte wifh Mfiom
Is Na propBM1y in Cuestion: Mnua%ASSasmd
❑ Re� Property ❑ Mnuatly Assessed
�
_ a0o� .....
"� Drawer NO ............. �M
,�w c�ra no. ..a3a1........ �
— �ci1,So3�� _
20_ \� I _ I 20_
I/ We certify urder the pei}bfty of perjury Nat tlte a e and fwegoing information is We and corred antl Ihat the applicant is a resaent o/ Indiana and
owner / mntract buyer of �% atorementbned on Cate apptication is filed.
�natu�.(4i'^'rfs hA ) . � /� • n Oata (mm1h. OaY. Yo�
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persm (numEtr anCStlea( tity, ffite. aW LP rodo)
Date (mordl+. Oay,