HomeMy WebLinkAboutMortgage_Evans'_ ^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
FOR DEDUCTION FROM ASSESSED VALUATION
�- � smce Fom, as�oe (Rii i s ov)
�` PrPSaibed by DeGa�M o1 Laal GovemmeM Firence
�STRUCTIONS:
b be filed in person or by mad with fhe CounryAuditor or Counry Recorder o! the counry where the properry is bcated.
Fi7ing Dates: i) Real Pmperty: Must �le durirq the year /or which the deducfion is soughl.
2J Mo6r7e / Manulactured Homes rrot assessed as Real Property: Must file dunng the hvelve (72J months
before March 37 of each year the deduclion is soughf.
See reverse side for addifional instructions and qualifica[ions.
t roroonvactbuyer-see anreversesile)
`{� Cqj����(,y7Auditor
� CdUY�t¢Recorder
'�Pa1°" � ,� / GIBSON COUNTY AU T
.�.
Tari�g �istra . Key num 1e9a1 CesaiDtion Reco(d numGrl Page rwmGnl
(vh,�.f�, - o _ a 3- 3 0- o 0 0. , q o- o i g / o s
AsesseE ralue d real PoP�Y as of hbrtgage/ Contraa inde6tetl�ss unpaid az ot AWr�qage I Contraa i�Webtednrss �mPaid as d Is Ne ePd�nt the sde
March 1. aamn 1� Mard� 1. artent Y� date of evP�� � a eC��e owndt
❑ Yes ❑ No
If m. wha� a his I her e�ct share of interest? tt ow�reO wi� wmeone other n spouse. iMicate wdh whom
1f name m recud's dMsan fhan that N appGrant, mCinte bebw h tM P�oGertY in purstim: Mrn�aOy Assessed
. ❑ Real Property ❑ Mmually Pssessed
� Mab�e Home OC 61.1=
Name of rtnrtgagee or contraG seller
of n»rt9a9re a mntracl
w oMer owner ar
city, stafi, aM ZIP mde)
qAAress ssignee (number anC stree4 ��te,^ M Z/P cod� )
7' 3 - �
Does aPptirant w.n ryoperty in any aher 11 yes, wh:
counry in Ind¢na? � Yes ❑ No
mon apyoved'o� itre ema+nl of:
20_ n1_
Si9runire
I/We
under ihe penalry of
/ ntracl buyer of the afor
/ /' �
Whal TOring I
i
COUNTY
�VAnnS �4Roc� RAy
�i y1.E E/J
/D �59�J
20 20 20 20 _ 20 _
Counry Date (rtmth. OaY Yea�
the abo rW foregoing infortnalion is true and mrtect and that Ne applinn[ is a resident of Indiana aM
prope n date applicatlon is filed.
Date (rtw+th, day, ysa�
FW msitlent address ol appGranl (numberantl shae4 wy, aria nr m
3boo �, aas 1,,� �-�-ok
Puson authoraed by tluy exeaited Power M Nta�Y a M IC 61.7-12-0.7
Pddress of a Wmraed per:un (num6eraM SbeeL aly. sfate, and LP mde�
l �J 4� �o �o Jo
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