HomeMy WebLinkAboutMortgage_Anderson (13)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
7__ ,; FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fam 43709 (R71 / 6-09)
,,�,� PresoiGed by Departrtrenl af Lxal Govemrtrenl Fitwce
� INSTRUCTIONS: c ' ead�q»
To 6e fiied in person or by mail with the CountyAuditor or Counry Recoider o! the counry whefe the property is located. `� o�[ U IC
Fifirg Dates: 7J Real Property Must file dunng Ihe year for which the deduction is soughL County AudMr
2) Mo6de /Manu/actured Homes rrot asseued as Real Property: Must file dunng tAe fweAre (12) months C� �
6efore Marclt 31 of each year the deducfion is sought �unry Reoorder
V
SeereversesMeforadditmnalinstructionsandqual�cations. GIBSON COUNT
Appfit�l(ownercrconUaye�uyer-seere�sMCeontonrevers¢side) _ ,
73titg
�
As�sed vaqc d real poperty as of
A1arU i, anetrt yrx
It ro, what is his I her erad share o( interest?
It name m remd is Oirterent Nan that oi appOranL hid'uate Oebvl
Name ot rtqrtBa9ee a contrad seller V��
ACdress N nartga9ee a mntrad se0er (number eM sVee; ciry, s�le,
Name al assignee w othrJ oxner or Imlder of mMgage
ACdress of assignee (number aM sveeL my. stafe, aM LP cotle)
Dces eppliont ovm pmperry in any oNer It yes, wha[ county?
counryinlMana? r� .. r-� _'
Detluction appraved in ihe artrount of.
20 1 20 1 20
�V � v � � � �J
as of Martgage / Cmbad iMeMedners unpaid as of b Ne app&ant the sde
Eate of appfi�tion iegal w equBade or+�el+
❑ Yes ❑ No
mmeore oiher tl�an sPW�. mdxate with wMm
Is tM {wperty in puesUm: MnuaOy Pssesse0
❑ Real Property � Mnually Assessed
VJhet Taritg D'btrid7 Has Nis dedurlion Oeen requeste
tWWtRntY2d(! ❑ YE
)UNTYAUDROR
20 _ 20 : 20 _
Counry Date irsw�vh. tlaY. Y�A
m P�openY
❑ No
20 _
I I We certify under �he pena�ty W perjury that N above arW fomgning infortnation is We and correct arW that Ihe appli�ant is a resideni of IrWiana and
owner I mn cl uyer of lhe ntion perry on date applicabon is filed.
7�w (o Date (+rpnfi. daY. Y��
il e of ap�fmant (n mber treef, late, end ZIP oode)
J
auNO�aed Cy duy executed Powcr dAnnney or by IC 61.1-12-0.7 Oate (rtpmh, Eay, yea�
person (numDeraM sneet, tiry, state,