HomeMy WebLinkAboutMortgage_Fowler (2)^'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
� FOR DEDUCTION FROM ASSESSED VALUATION
� � . � Sfa[e Fwm 43709 (R71 / 6-09)
�` � Presoibed by DepartmeM af Laml Govemrtrenl Firance
Fite Mark
��NSrRUCnoNS: AUG 2
To be filed in person w by mail wifh the CounryAuditor or Counry Rewrder o! the counry where the pioperty is located. � ��
Filing Dates: 7) Real Property Must file durirg the year for which Ihe deduclion is soughL � County AuditW
2) Mob�7e / Manu(actured Homes not assessed as Real Property Must file dunng the nvelve (72) mon�s
6efore March 31 o(eacA year the deduclion is sought Counry Recorder
Seereversesidetaadditionalinstructionsarrdqua/fications. GIBSON COU
AppGUnt (oxTer or c t buyer - see msfnrtions M rs
7 �istricl Keyn ber/legaldesaiption
.
Asesed vaNe d rnal poperty a d hbrtgage / Contraa
Martli 1. ar�atl yrvr Ma�ch 1. wrtent yeF
tl ro, what Is his ! her e�a share of inferest?
If nane on remN is drtfrlent ihan Ihat ot aOP��i �irate below.
Name of moriga9ce trarl seller �_
Addrzss
streeG ciry, slare.
mortgage
(number aM stree4 �Y, sfafe, aM Z/P code)
Oces applinnt own p�operty in any other
counry in IMiana?
❑ Yes
Deduction approved in ihe amount of:
20 20
Signad�re N CounH Auditw
ao� a�y5� 3
unCer Paae numbu
� �.i�.i
unpaid as ot Mongage / ContraG irMebtedness unpaid as of Is Ne app0�ant Ne sde
date of epplicatm legal a equitahle ameR
❑ Yes ❑ No
It awned wiM someo�re dher Ihan spouse, kdipte WN whom
Is the property in QuesUOn: MnuaM Assesud
❑ Rea� Roaenv Q ?!°n!aM Assessed
If yw, what munt/1 VJhat Tadng Districl7 Has Nk tleEUCUm Oeen requeste
mr a,rrent yean � ve
COUNN AUDROR
20 20 20 20
counry oate (monN, day, yea�
20
vrop�i
No
I/ We ceriify under the penalry of perjury that Ne above and toregoing intortnation is we and correU arM Nat the applicant is a resident of Indiana arM
owner I conVacl buyer o( ihe aforementioned pmperty on date applicatlon is filed.
�naNre (ovme�s hN reme) _ Data (rtmfi, dey, yea�
state,
Person authorrsed by Ouly exeated Pwer o(AUwneY m by IC 61.1-12-0.7 I Date (rtpnN.
Pddress of aNhw'ved person (numberarN svee; tiry, sfate, and ZIP mtle) .