HomeMy WebLinkAboutMortgage_Koch (6)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� snca Fam a3�os (R„ i s-os>
S�.,. aresaitae ny Deva�m or lorai Govemment Firence
INSTRUCTIONS:
To be filed in person w by mail wifh fhe CounryAUditor or Counry Recorder o/ the oo�nry where the property is located.
Fitirg Dates: 1) Real Property M�st fde dunrg the yearlo� which the deduclion is sought.
2) Mo6Be / Manufactured Homes not aucssed as Real Properly Must file dunrrg the fweHe (72) monfhs
before March 31 0! each yeer the deduclion is sou�ht.
See reversa side 70� adddfonal instluc7ians and v�,6li�cations.
� vaM d� qapaty az ot
Matl� 1, w'MU year
�
�i M. Wh3115 ht5 / 1Ml ¢Ydf15h2l8 O( II11Bl¢Sl?
tt name m recad "a drtte�ent than ihat
Y ���a,a�mr
Caunry Recorder
" � GIBSON COUNTY AUDITOR
/ legal d R�md mimber� O Pape �/
6- �-ai- �ov-«�o.ava- a- �
lortva traa IrdebteEneu unpaitl as af Abrtgage / Con� iriEehtedr�s unpaid as d is Ne appfvant Me sde
lard� ptyyrO sy_-� date af app42tion legal O Y� ownel+
�\ � P "Y 1
`J l./l./ ❑ No
If owned with mmeone ather ihan sCa+�. IM'cate witli whom
Is Ne property in QuesOm: MmieOy Ascssed
❑ Rea� Ropertv ❑ ArmualN Ass�ed
�mtgagee a mntract se�er (numDer and sLeeL �y. smte. aM ZIP code)
Name of assignee w oC�v wmer or halder af matgage
.naaress m ass:�eelm,�wa. �n �et a�: smu.
eodifant wm
Dra�ver NO. �O/ �'.....
Card NO. ...��� 9.........
� S .�, S SU =
Mas Iha deductim Ocen reQUesteE m property
for arterLL �maR ❑ Yes
❑ No
COUNTYAUDROR
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�� �,�. �Y,��
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I I We certify uMer the penalry of perjury that Me above arW foregoing information is true and cortecl arM that the apd�mnt is a resident of InCiana aM
owner I ntraU buyer ot ihe a(o2mentioned property on date appliration is filed.
InaGi (o�me/s fifi 1 /` /� Date (/rmCi. daY. Y�/)
rmress ot ewromed vaso�
atate, enC IIP mtle) /
� (iCaJend v� i
oy ic �,.,-,z-0.�
sneet �'+�Y. stete.
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