HomeMy WebLinkAboutMortgage_Colvin"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear .�
�__ .� FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709IR11 /609)
,,�,� Presoihed �y �epartmeM of Lxal Govemrtrerrt Fi�ance
File Mark
INSTRUCTIONS:
To be filed in person w 6y mail wifh the CounfyAUditw o�Counry Recorder of Ihe counry whe2 the property is locafed. � �
Filing Dates: 1) Real P�operty Must file durirg the year lor which the deduclion is sought. nry Aud'ROr
2) Mobde /ManuFactured Homes not assessed as Real Pioperty Musf file during Me tweAre (12J months ���
befo`e March 31 of each year the deduction is sought Rearder
See reverse side 7or additional instnictlons erM qualifications. GIBSON COUNTY AU DITOR
ed vahie d real p'aperty az ot
1. ar�enl yrdr
e= �ber I legal d �
Mp�p�ge/Cc
Merd� 1. a�@
ro. whaf is his / her e�raa s7we ot interest?
1f twne on reooN
Nartre ot rtartBa9ea m
.44dress of rtnrtgagee or mntraa seAer (numba� and sfreet UN, s7ate.
m holder W rt�ortgage
ot assignee (number aM atreeG rby, state, erd ZlPcnde)
Does aPD�nt o.m poperty in airy
murLLy in Indiana?
❑ Ye!
Dedudion appfoved In the amount �
za zo _
IIWec
ownerl
Prfson
� — Retord number Page numb�
^ O ,380 O I
iess unpaid as of Mwtgaqe / ContraC'vdebcedrress unpaid as d Is Ne appircsnt the sole
tlate af applkatrn legal w equilade owneY?
� ❑ Yes ❑ No
IF awneE wiM wmeorie oNm than spouse. IMicate wi�h wfiom
code)
� _
- :,�.�►� �o....aoib.:..�..
z� Card NO. .�.�.�........
_ �(�,y pt�, 53
Is IM property in puestion: MnueDy Assessetl
❑ Rea� Prov�RY ❑ A"!�!�v.�
Has Ih"s de0uction Deen 29uestetl m pmprny
farartentyraR ❑ Yes
❑ No
�
Date,,rro�rth. dzY N��
zo
ler Ne penalry of perjury that the above and foregoing intortnation is true and cortec[ aM Mat the applicant is a resident of IrM'�ana arM
buyer ot the aforemeMioned property on date application is filed. �
y� ) ,' . Date ( aY. Y��)
W appfxanl (nu �� ntle ahee4 �'d1: �te, antl LP code) � //
dWy executetl Power W Atmrt�ey w by IC 67.1-12-0.7 Date (monN. daY. Y��
o(autlmmeOperson (numbe�anOStreetc%slate.