HomeMy WebLinkAboutMortgage_Peterson^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
,_ � FOR DEDUCTION FROM ASSESSED VALUATION
� Sfffia Fartn d3709 (R71 / 6-09)
� f PreSaiDed by Departrtren� o( Lordl Govemment Fnance
�e
INSTRUCTIONS: I �qy�
To be ned in person w by mail with the CountyAuditor or Counry Recorder o/ the county where the property is located. J � L U�2
Fi7'mg Dates: 1 J Real Pmperty: Must fik during fhe year /or which the deduction is sought. C �_Counry Auditor
2) Mo6de / Manufacfured Homes rrot assessed as Real PrtipeRy: Must file dunng the Iwelve (72) months
6efore Ma�ch 37 0! each year the deduclion is sought. ry Recorder
See rnvers e foraddtional inst ' ns and qualifirations. GIBSON COUNT
Ap nt r mconvarl buyer e ' ns m rever/senside)`
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Ta�d Dis ' / Key ber / le9al desaiPtim C JU — ��. 0/ CJV —V �, Remrtl /o[ P��� �P
llfti�
ps�st.y veWe U real qoperty a of Mortgaga / ConbaG'vdebtedness unpaid as o( Mortgage / Convact intlebt�qness unpaid as of Is Me apd�� be sole
Me�di 1, aarent ymr Mamh 1, airtent year Eate of aDP��^ � legal or eQUitade ownM
❑ Yes ❑ No
11 no. what's his ! her euU share ot intelest? If awned wiN somew�e oNm Ihan . iMicate with wim�n
If name on recad is tlifluent Nan Nat of aPP�^l �icate bebw: Is Me properry in Questim: Mnua%ASSesseO I
❑ Real ProPertY Q MnualyAssessed
MoMle Hame QC 61.1-7)
�nme m rrot�asee a rd,vati seuer
Address of nwrtga9ce ar wnhacl seder (number and e�iry, state, ard ZIP
Name of assi�ee w other awner or hdder o1 mort9age
PdCren of assi9�ce (number ard stree4 �Y. s�ate. and L e / / /' • ^ ^!` . /'�/ � �/
�O / �!I �J lJ
Oces appllnnt ovm pioperty in any oUer If yes, what munry. What Ta�dng District7 Has tt�is detludion Eeen requested m propesty
munry in InOiara? ❑ No fw arrent yeaR � No
❑ Yes ❑ Yes
COUNTYAUDROR
Deduc6m approvad'c� ihe amount ot ,
20 20 20 20 20 20 _ 20
SignaLrte W Coim�YAUditor '� . - _"".,„yh tlaY.Y��)
I/ We certi un the nal of u that lhe above and for oii resident o� t�iana arM
er/con � eaforementi nedpropertyondateappli� Dl�a}�'e1' 1`rO. �I
ruW (o � .................. i, daY.Y��i
� ca��� ���o. ....1.�6a� 3 ao��
� FiQ nt atlNes^ of a number anE streef. dN. �te, and ZlPmtle) . . . . . . . . . . .
�► - �7s� o a t i�l`�b � 55t). Uv
Pe1wn autlpirzed by duly executetl Pawer a(Attomey w Cy IC 61.1-12-0.7 h, d2Y, Nee�
vAOtlrass of authoraed prlwn (numbereM sbce; dry, sta�e, antl ZIP oode) .