HomeMy WebLinkAboutMortgage_Baker (7)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou T i Year Q/
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� . �• State Fortn 63709 (Rit / 609)
S I Presaibed by Department af Local Govemmenl Flrence
� JUNF� M�011
wsrRUCnoNS:
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To 6e (led in person or by mail with the County Auditor or Counry Recorder of the county where the properry is located. C .
Fil'mg Dates: 1) Real Pmperry: Must file during Ne year (or which Ure tleduction is sought � Audiwr
2f Mo6ile / Manufactured Hort+es rrof assessed as Real Pruperty: Must file during the hvelve (12J months �'7 8nr�d
beforaMarch37ofeachyearthedeductionisswght GIBSONCOl3AlTlf� it�tt �
See reverse side for additbnal inshuctions and qualifications.
T" isbfrl V Key nunberllegal desaiption Rem�d numDer Page rum�Ger.
' ��,:�,.��-� a�-/a_o6-Yoa-ooy.3a6-b�8 � a533
AssesseE vWUe cf rral qoperty as of MoRgag e/ Contract 4deEledness unpaid as ot Mongage I CmVar1 i�ebteAness unpaid as M h Me aOW�� Ne sole
Mamh 1. ammi year Mard� 1. ar2nt year tlate of appGtation legal w eduibde avne(1
� Q Q Q(� ❑ Yes ❑ No
rc �o. wmst is nis � hu e.aa snare or inferesn rc awrrea vrim somearie «1w1 uun spouse. inaica+e vrim wlnm
If name M iemrd is AiRerult than tha� of aPP�icant iiMiWte bebw. • Is tl�e WePeKY in 9uPSti0n: AnnuaM h55e55e0
eal PtoPenY ❑ �Y�
Modle Hane IC 61.1-�
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Address of mort9a9� ot cantraG seDer (nurtibrl and stree4 �Y. sfate. aM ZIP code) —_ .—_ .—' _ -�
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Oces applicant wm pmperty in any oNer
counry in Indiana?
❑ Yes
oe�uc�m, epprwee m ure amwk m:
20 � 20 _
a,ano�
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No
�o�
20 20
� (O
Wha� Ta�atg Dis'
20
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I/ We certify under fhe penaly of ry Nat Ne abo rW foregoing infortnation is W e and correct arW ihat the applinn[ is a resident of InEiana ard
owner / mntract Wyer entioned prope date application is filed.
�re (owne ireme) Date (rtmm, daY. Y��)
`
II ' e t t, dry, state, ard ZIP e)
(SI C✓: v 6� t� a. •••« �ar 1-r/ �17G 7 0
rson aWroraetl Gy duly exewted Power W Attuney w by IC 61.1-12-0.7 Date (monN. Eay, yea�
of author¢ed person (numbermMSLee; cky, Stafe. ana