HomeMy WebLinkAboutMortgage_Shore���
°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION MAR
s�aca Fom, a3�os cRS, z-0�,
�' � Prasa3ea M Depanmen� u Lxal covemmeirt Frence
—1-..
2009
` � File Mark
INSTRUCTIONS: GI�SON COUNTY AUDITOR
To be �led in person or by mad with the CourrtyAuditor o/ the county where the property is loca ed.
Fding Dates: 1 J Real Proper(y: Dunng fha f 2 montlis befae June 11 0/ the year the deduction is to be eRective.
2J Mobile Homes assessed �mder IC 6-1.1 J: Befween January 15 and March 2 0/ the year the deduclion is to be efleclive.
See 2verse side for additanal ins6uctions eM qualifications.
Apqi�au(amer�{�rAradbu�'er-seere�revqmsde) )
prope,ty as at MaRh 1, anerrt yeer
If ro, wnat is h"s / hd exacl share of interest?
If reme an recartl is different ihan lhat oF applicam, indi�
Name of mongagee or oonlract seller
�
Address of mortgagce a oonlraC seller (numbe` and s1
Nartre of assgriee or W�c+o.vner a hdder of mMgag�
Address of assgrree (mmrber arM sLeeC cily: stafe. a'
Dces applicaM axn W Werty in arry dher
�� � �����
❑Yes ❑No
Deduction app�oved in the amwnt of:
zo 0 9
I / We
Person aNhwaetl by duN ��
AdNess ot authoraed pe,san
2o I zo
I D
saiPUon .,C i" �'a/ Reoordn 1 FageD
ge I ConUad inde6tedness unpaid as af Mach 1. Is e appRrenl Iha sole legal or eqirilaWe wmeR
alRenlyear .
❑Yes ❑No
If owned with mmeaie alher Ihan spouse, u�dcate wf�h whom.
xlow: Is Ne propeAy in quesGm:
eal Pmperty ❑ Mobile Hane QC G7.1
�f$Q/ il'/lfn'1
tily. sfate. ard LP oode) -
� � �a is o�, ,,,, ,�
"`r-�+-„" '�'L'0
�, -
✓ r-�
" L
'�� 9-/D� r=
zo � zo
Counry
dedudion been requesled on property
nt yeaR
❑Yes ❑No
zo
oa�e
zo
of perjury Miat ihe above and foregoing intomiation is true and corred and tlial tlie appGnnts was / were a resident of
n y on March 1, 20
oale (manlh. daY. Y��
�D/1� h �-n�,2oo9
pty, Stale,
w by IC G7.1-12-.07
aM sbeel, aty, sfafe. arM ZIP rnde)
/-/
�
(mm(h. daY• Y��
4