HomeMy WebLinkAboutMortgage_North^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township vear
_ + FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm G3709IR11 / 609)
�` j Presoibed by DepartrneM of Laal Govemment Fnanm
File Mark
fNSTRUCTIONS: �AN 1 �ry;
To 6e filed in person w by mail with Ne CounryAUditor or Counry RecoNer of the counry where the property is located.
F7irg Dates: iJ Real Property: Mus7 fJe during tha }rear Por which the deduction is mughL C.'J. County Auditor
2) Mo6de /Manufadu2d Homes lrot assessed as Real Prt�peRy: Must Ae during fhe fwelve (12J rtwnths
before March 37 oleach year the deduction rs spght. County Recorder
See reversa side 7a addrtional instn�ctbns end quali�catbns. G IBSON COU
nt (owner moontract buyer- see iesUir�gra m reverse siEe)
1 vaWe d�i Raper:Y a of
anPJlt year
rq. xiuf h h's / Irer eud shale Of intere5t?
-in -r��-
b�tgage / Contraa Irdrbt
Aa`rh 1. a�rrent y^°•
If fwrre m reoor0 B d�Ruent Nan that ol appOCant, u�ONate belw!
Name of rtrtxigagce ar mntrarl selier ,d /J _
irr ,d ��,
ti —�c.��
qdd�� of mort�agee or wntrap u0er (mmbri and saeeC rdy. sm�. erN ZIP wdej
er or hoNer M mortgage
� 5free; tlty, 51ate. an0 ZIP code)
.r.c� - 3-
anY oNer I( Yes. wh
De�uaan appmred 4� tlre amwnt of:
20 _ 20 _
Sigre dCambnuaimr
�•
• L• Yk
I/ We cerroy unAer the penalry ot
wmer / contract buyer of the
(ovmefs IfA n )
FWI t aE a t(nurp
`��
Pe�„m auNO(aeC by dWy ezetutetl Pow
�
-000.3y8-oa� ao
�aab � m M«�a9e � ca,:�a �aec�ea�ess �maau as w
date af appGmtion
/ I �03
Is Me e0p�+l tlre sde
�gal w epultade oane/�
❑ Ye5 ❑ No
H owned wiM sameorre othel than spouse. mdxate wiM wMrn
,sdv�+�
Is Me DroPenY in Ouestion: MnuaM Assessetl
❑ Real Property Q ArmuallyPSSeSSed
Mas Ihis tletlu0irn been reVUrsted on piopMy
��� ❑ Yes ❑ No
)UNTYAUDROR
' /�u4i�( IIRTsr1,�i-i�
Z�JW����
Coumy
the above a�regoing infortnation is true ;
ProPenY on te aPdication is filed.
c��n
by IC 61.
of aWro�'ved prlsm (number aM snee; cAy; state,
aU/� �03
tlay,
�.