HomeMy WebLinkAboutMortgage_Davis (8)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count� 7ownship vear ,
_. FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 63709 (Rt 7! 6�O�J)
�,,,, PresCriOed by DepaRmeM of lotal GovemmeM FinenCe
File Mark
INSTRUCTIONS: �
To be filed in person w by mail wi[h the Counry Auditor or Counry Recorder o/ fhe county where the property is located.
Fifirg Dates: 7) Real Property: Musf fik tlurirrg the year lor which the tleductior. is sought. nry AuAitor
2) Mobile / ManWacfured Homes rwt assesred as Real Properry: Musf file dunng Ne IweNe (72J months C' �
before Maroh 31 o/each year [he Ceduction is sought. ty Recarder
See�eversesideloradditionalinshuctbnsandqualifrcations. GIBSON UNTYAUDITOR
MWf91tt(ownera-contr�ct�ye�-seere a�r9uerseside) � /) n -
Memh 7. arm�q yrar
� tt �a. what is his ! her ezaa share ot interesf?
ar2nt yeer
1f rame m �emrd is tlAfemnt Nan that of appUCan; i�Micate Deb�r.
Name oi mutgagee or mntraU seller
Address of mort9a9ee or mntraa
(numDer end sneel, ray, slate,
Does appti�nt wm poperty in any dher
counry in IMiana? ❑ Y�
Deduction aPPm`ied in Cre amouN =
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20—,� " �\(��� ��
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sg�atu�e . �,,` e•
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I/Wece� �1O•
ovmer / cc G'J�
FWI `' ent aCdre _,.pficani (num0er
5�6 G�- ��ay S ,—.
Person auihonzetl by dWy ezecuteC Powei
No
sLeel, citY sta[e. eM:
7��
nd ZIP code)
n ra. w+,ac cowN.m
^ ^\\
V �
���a
tlate o( applicatbn
rc �,ea wm, � m�
W�at Tadtg Distrk
�OUNN AUDROR
'0 20
number
I legal a epuilade oxne(.+
❑ Yes ❑ No
wm, �
Is property in Question: Mnua�y AssesseE
Rea� PropeM ❑ nrmua�y assessed
Has Na tletlu�lion Ecen reGUesteE m V�Y
m. cu�ren� rear? r-i .. r-�
�
Da(e (month. deY, Y��
20 _
_..ve and foregoing information is true and cortect aM that Me applinnt is a resident of IrWiana aM
. ixoperty on date applicatlon is filed.
stere,
Or Dy IC 61.142-0.7
peism (numberarM Sbee; city. state. anC ZIP mCe)
�i67o
Date (rronth. daY Y��