HomeMy WebLinkAboutMortgage_Meade (5)'° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS oun 7 ip Year
_ FOR DEDUCTION FROM ASSESSED VALUATION �
� s� F«n, a��os cR„ i bas, �8_ a� _ !/
��.�. Presaicea q Depertmea d Lam Govemmera Frence 'p
INSTRUCTIONS: 'yU y °''e ��
To be Red in person w by mad wifh the CounlyAuditor a Counry RecoNer of Ne owin where Ihe F� ���
Fffing Dates: 1) Real Pro Must file du ' Ne ry ��m ��t�
perty: rmg year (ur which the deduction is sough[ �"J7 .µ �� nry Auditor
2) Mob�le / ManulaGu2d Homes not assessed as Real Property Must Ae dunng the fweNe (12) imriMS /- ❑
6efae Malch 37 o/eaM yea�the deducSOn rs sought. GIBSON C UNTY q�nry Remrder
See reversa side !or additional instructions antl qualifications.
Ma���(ownerarmno-aeb -seeresffc4�s,mAK+ms�i
wssessea
AWrh1.�
tt ro, what Is h'a l lcer exact share ot Interest7
If nartre m remN e WRumt tl�an Ihat of app6r�ant, trMkate Dtb+`
«oonran
lLti-'."'-.�'�:!
�
5ete, aM
Name al assignea or othe� owner ar halder M rtiortgage
P4Cres5 at assigfree (numbar end sfiae; My, 5lete, entl Z/P cotle)
Dors ePpliwrt own p�operty in eny oNrl
counry m InE�ona? ❑ Y25
❑ No
Deduc6on aOWuve7 N Ihe amount of.
20 20
I/ We cert(!r undel�e penalry of pet�
rnm r I contract b�r of the atore�n
sgraw (ornelsh�nert») {
FW U (rwmeerane
Persm aWn�d hy d�ly esttuted FbYV ot /
Pddrass af aW�ortred persan (number aM sb
-/ �
�i=i��
'-fJ v0. �Ga'/-d /�7 - - i%5 � 0 �-
i� m M«yaq<i c«,r� �m� �v� xi a �s,n� ema� a,e mm
data o( aGP�� � � �� �
❑ Yes ❑ No
It owried wiN mmewia dher ihan spouse. udkate wiN whom
Is Ihe property in GuWiav MnueDy ASSessed
❑ r� a�oaertv ❑ ?nnuan�i n�ssee _
Dra�r�cr NO..�.�� .......
Cal'(� ���. ...�:!.:.J.........
� `.�, 9C0 . °D/
Counry
zs Nis deduction Eeen reGUesred m G�PP+b
� �� � ❑ Yes ❑ No
.�•��i.��
� � /�%�}�il� �� � � � � —� U
0
thal the above arW foregoing infortnatim is true and cortea and that Ne applirant is a resident of IMiana and
ned P�oPenY an date apqiration is filed.
, Date (nnnN, daY. Yee�
�:
Oy IC F7.14
entl LP code)
�ate (rnunth. d�: Yae�
.�t