HomeMy WebLinkAboutMortgage_Barrett (3)�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
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INSTRUCTIONS: '
To be filed in person oi by mad wdh tl�e CounlyAud'rtor of fhe couirty where tiie propeAy is bcated.
Fd'ag Dates: 1J Real Property: During the 72 months before June 17 0/ the year the deduction is to be efleclive. ^ p p���
2) Mobile Hames assessed imder IC 6-1.1-7: Betxeen January 15 and March 2 o/tl�e yeai tha deductian is Cd b�� 2009
See ieverse side /or additional insWCtions and quafi(itations.
Appican eidmrA�tbuyer-seere " reversesde) C/
� GIBSON
T' DisUic7 Key number / legal desaiption ReCwd mimber ai
� � -6�0./�S-� dZ 06 ?73
Asa�ssed vdue oF real paperty as af Mard� 1. wrart ymr A1Mgage / ConiraC indebtedness unptid az of A/arrh 1. Is the app5cant Ihe sde legal a equifable owna/1
a'rterC year
�G (f� ❑Yes �No
If�what is his / her exad share d irMrest? If owred wdh someme other �han spouse. iMtcafe wilh whum.
if reme m reard is diRerent Uun that of applicanL iMiwte belwr. Is e praperty in puestion:
R�I P�operty ❑ Modle Hare pC 61.1
Name a1 matgagee or cmlraU seller ���n. �.
L
Address of mortgagea a conUaC saller (iwmber aM strae4 dN. ffife. aM LP code)
Name o( assignee ar ather owner w hdder d mortgage
qddress pf assipnee (nrtMer aiM sGeet, tlty, slate. eM ZIP mde) .
operty in a�ry olhm I If yes. what
❑Yes ❑ No
i
Dedudion approved in Ihe amwM of:
20 20
— '
Sigrmwre ot Camry Audaor
/
I/ We certify undar the penalty of perjur
Indiana and owner of fhe afwementione�-
Has ih's dedudion been requested on poperry
i01 QIRBlII YBB�i
❑ Yes ❑ No
� idenl addre,ssI o/f applirart (number and s4eat. aty, sfeM. aM ZIP mde) ^� /�
v!J' �. �l � ^%� ✓ LG.� �/ /(O lo �
aerso� a�nhaaed M duy ��,.,rted � du�n+er «cy ic ��.i-iz-.o� o�
Address of euifror¢ed person (numbe� eM sfreeG city, stale. and ZfP code)
20
ilA, day, yeeA
was I were a resident ot