HomeMy WebLinkAboutMortgage_Ice (2)"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vea
_. , FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Farm C3709 (R71 / 6-09) L/
��«. f a�ewibed by oeaartmem at �si Go.emmen� Frmnce
File
INSTRUCTIONS:
Form I�etl wiN:
To be lled in person w by mail with the CounryAuditor or Counry Recolder o/ the counry where the property is bcated. >''1
Fifirg Dates: i) Real Property: Must fi!e durirg the year hr which !he deduction is soughG � C� 8 6ddn� q�dimr
2J Mo6de / Manufactuied Hanes rrot assessed as Real Property: Must file dunng the hvelve (72) months
before March 37 0! eacA yenr Ne deduction is saght. ❑ �^tY R��
.-.
See reverse side for additional insuuc7ions arM qualificafions. <� ��
Appfuant( rm�biKer-see2sfirSa➢Smreversesiie) J
- - a-��-/��-e�v.�39a-
AsussM va4re af real poperty a d Abrtnage / Contrau inde6tea�ss unPaiE as N Mwtg
M1terti� 1, artml year Memh 1, a�rtent year Oate �
I( no, what Is h'a I her exafY share of interest?
It name m�v.ad is QMerent �han Nat of aPP��l hidifate Debw:
name m rt�ortgagee w mnvact seuer �/�
Add2ss of rtartgagee w wntraa seder (nunDr� end sbee; cdy, state, aM LP code)
Name N assignee w dhu owner or htlGer of rtart9a9e ' / /
�U U
MCmss of assignee (number aM stree; ciry, state, an0 LP aotle)
Does applirant ovm property in any oUer It yes, what munty?
munry in Ind'ana? � � _
cbon approvea In Ine amount at
20 20 2q
It owned
GIBSON COUNTY AUDITOR
Remrtf rwmbu P�e wp�Ca�
� /O � j�
nbaC mEebtednesx �mpaitl as of Is the appfxsnt Ne sole
nim kgal a eWilaNe awnM
/ ❑ Yes ❑ No
other Ihan spouse. indira[e wiTh wlwm
�RIs ProPenYinQuestion:MnuallyAsussed
eal RoPenY ❑ ��!�Y.� . _ _
— W�nY
❑ No
�
GOUNTYAUDRC a � ' O••' � _
v�'l\\Cl. \�...........
20 q I!. . . . . • _
� � ...
C�� d \O. ...
ISig�atufedCmmbAWttor ICounry I ,...,wmi.daY.l��
I/ We certify under 1he penalry of perjury that the above arW foregoing informalion is We and correct and that the applinnt is a resident of Indiana aM
owner I mntrad buyer of Ne aforemeMioned property on date applidtion is filed.
� Sig 6 hm rmrtre) Date (rtm(h. daY. yseA
u0 rnsitlent aEdrnss ( nt (number end 5Lae4 m}; sfate, and Z!P catle)
% �j08� �/II.� rPe� f �,��t�P{O
Pgson autlmrizeE Dy duy ezewted Pw�er ol Mmrey or by IC 61.7-12-0.7
Address of auUwrard person (numberantl sIIeel. cdy. sbfe, and ZIP code)
i�7676
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