HomeMy WebLinkAboutMortgage_Bailey (7)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ .= FOR DEDUCTION FROM ASSESSED VALUATION
• Slete Fortn 93709 (R11 / 6-09)
1 � Presmbetl Oy �ePartnreN of Lod GovemmeN Fuiarxe
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INSTRUCTIONS:
To be filed in person or by mail witlr the County Auditw or Counry Recorder o7 Ne county where the pmperty is located. ��
Fi7ing Dates: 1) Real Property: Must file during the year /or which the deducfion is sought. /�pp C 1 Counry Auditor
2) Mo6de / Manulactured Homes raf assessed as Real Property.' Must fiie dunrg the nvelve (72) Mbr�s+� � I
6efore MarCh 37 of eaCh year the deduction is sax�hG Cou^lY Recordu
See reversa side tnr add'Rional instructions and qualifiwtions. C���
nppfcant(ownerac«irraebuyer- ��verses+de) GIBSONCOUNTYAUD�TOR
Ta � istrwl . rvrtnber / legal OesaiPtion � RemN number Page numEer
-ia- zo -aDa.o��-o�.8 YYd-g
Asessetl vdue d rral P�WertY es d ge/ Contraa 4de6tednrss unvaid a o( Mmgaqe / ContraC "uWebtedness �mvatd as ot is Me e0d�+t rhe sole
nte�d� 1. a.�cn ypr 1. a�rmm r� aate or saa�� � a ea��e �
1 9_ �� d ❑ Yes ❑ No
tl ro. what is his / her exaG share of interest?
II rwne m recad's dR. uent Wn that ot appOCaN, mAifate
Name of nkutpagee or mntrs�Y seller / �/ _ n �- _` �� I J �
�.}�` V ��I`•vr {..�Y�/� �
ACdress of rtnrtgagce or mntrad se�er (n`miber and sLeeL ciA: sbte. ard LP oode)
Name W asvgnee or other ovmer or MICer d rt�ort�age
wm ryoperty in any oNer
a� ❑ Yes
or��n avom�ee m ub amwnt
�
�,��e,
37 //38
�f yes. wha� mu�t�/1
20 _ 20 _ 20
Si9ranue d cam—b}�.aiEimr
G• 1.
I/ We certify under Ne penalty o rjury Nat Ne
owner I mntract huyer of the aforeme�oned pro
d dOMFa�i (num0e�.entl sbee(,
wre� iavig u�smar
20 I 20
sDOUSe. inaicate wrtn wnom
Is Ihe prapelty in Question: MnuaOy Assessed
❑ Real RoPenY ❑ ���Y�
Mob�e Horrie pC 6
n
_nra��.,� a��
a""'8 � �15�0� 8
2q _ � zu
e arM foregoing intortnatlon is we and cortect aM ihat Ne applirant is a resident of Intliana arM
on date application is filed.
Oate (rtnrtlh. daY. YaeA
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Psmn aulha"v.ed Gy duy exenrtetl Poxer W Aum+eY � M IC 6i. -t2 .7
Add2ss of autlrometl person (number aM sfreet ary, sb(e. and ZIP mtle)
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Date (rt�th. Efi: Yge�