HomeMy WebLinkAboutMortgage_Archibald—^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
� FOR DEDUCTION FROM ASSESSED VALUATION
• Sfale Fortn 437W (R71 / 6-09)
S ! p�y��p� py pepyrtmenl of Lxal Gavemmenl Ffronce
�sraucnoNS:
To be lled in person w 6y mail with the Counry Auditor or Counry Recorder of the counry where the pmperty is located.
Filing Dates: i) Real Property: Must file during the year (or which the deduction is sought.
2) Mobde / Manufactuled Homes iwt assessed as Real Property Must file dunng �he nvefve (12) months
before March 37 of eacA year the deduction is sought.
See reverse side for additional inshucfions and qualificatrons.
n��r t�..,w� m m�trart bu�er - sBe rasfir�hu�s on reverse sidel _
a/legaldE
-la-�
Mortpage
rch t
If no. what is his I her e�U share
Y�
9u ry{�Auditor
C t}Recorder
� GIBSON COUNT7
- 0�3. 0 7�6 - o,� f� ���o !�-
1nPSS unpaiE as W Mort9a9e / Contrari udehted�ss unpaid as of Is Ihe
dateotaDO���^�� ���
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- u mvrrea wim someare otM! man . iMkate witn whom
11 �artre m tecad's 6Ruent than ihai of appfranl. in0icare Gelow.
Name ot mwt�agee « mntr'aCl se0er (�
7
Address of mortgagce ar contratl seller (numher and shee4 ury. sfate, and LP codej
Name ot assignee or oNU oNner w twlder oi nqrtgage
p.LCr¢ss assignee(nurtNerandsbee4 sfate.andZlPCOde)
���� '� / L
Does epplinnt ovm pmp�ty in any olher � If.w�...�.
munryinlndiana? � Yes ❑ NO
D�uctian approved In ihe amwnt of:
20 20
g Disiritl7
7
or epuitaNe owfre(!
❑ Yes ❑ No
I5 ttie P�o7ertY in Ouestim: Mmu%/�ssessed
❑ Real Roperty ❑ Mnually Assessed
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- Cat•d \�. ......��� .
20 _ 20 _ 20 _
__.�ry rDa�e Pnm�,. daY Y�/)
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1 I We certify urWer ihe penalry of perjury t the a a (oregoing infwmalion is W e and cortect arM that the appliran[ is a resident of Ird�iaru and
owner I mntrad buyer of the aforementioned property date applicatlon is filed.
� Sig (ovmefs hN n�a eln )I-.__, Date (monN. day Yee�
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FWI msident add�� ol appfcanl (wmDerand sbec4 dry, slate, antl ZfP oode)
�►5�1 s w�ti�� ' t�� � a, � N�67�
Person author¢eE by dWY ezecuted Power of AvomeY or Cy IC St.t-12�.7 �� (��. �Y, Yaa�
au@ror'¢ed person (numberaM sbeeL ciry. state,