HomeMy WebLinkAboutMortgage_Jines (8)".r °q STAIEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION {�'�(
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�O � Presoibed try Depanment ot Loral Govemmerit Firence ��
INSTRUCTIONS: �C�a`� 3 2009
To be filed in person or by mad with the CountyAuditw o/ tFre couMy where the property is bcated.
Fding Dates: 1) Real Property: Dunng the 12 «wnUis before Jmre 17 W the year the deduction is to be etFective.
2) Mobde Hames assessed /mder IC 6-1.1-7: BeMVen January 15 end Maich 2 0( fhe year the deduction is to be efi� ,Q �
See /everse side /or additiortal instructions arW qualificafions.
GIBSON COUNTY AUDITOR
Appye�rM1 (amer cr mntrad 6uyar - se strrcGOns m rererse aide) /j � ,
Distria ICey rn�rn�/�6ej�/ lef�l de�Eriplion�/ Remrd numbet
O �-O -o�o O. S7S-� 2-8 p
ed rd„e a re� �a�r � ar n�a�d, i, ara�u y� n�on�qe i convaa c,dewed�s ���d � or r.��cn i. is we a�wr�i u» sae u
a,nemrear �Q OQ O
If ro, whal is his / her ezact share M'viteresl?
�
If. m recwd is diRerent Uan that of applican4 indii
Nama af rtartgagee or coniracl saller �
Address of rta�gagee w mnUaG seller (�mba! an0 st
Name of assi9�e a olher wrner a holder of moAgage
Atldress ot assignee (rn�m6er aiM sfreef. dty, stafe. anc
Does applicanl own property in arry olher
couMy in Indiana?
❑ Yes ❑ No
Deduction apprwed in �he amounl of:
2b � 20 _
SigreWreafCpmryAudAnr „
sp�wse. �cate rriih whom.
pw
■1
❑Yes �No
Is 1ha propaM1y in qucsGm:
❑ Real Prooertv ❑ Mobile Hwne (IC 67.
� �.
'. siefe. an0 LP code)
, �
\
ZIP ootle) � �
. �
If yes. what camty? YVhat Ta�dn9 DisUicl7 Has this deduclion.been rmi��d' -' --�peity
s,,, _'__
/ J ��� 7 No
J�`'ES -
couNrvauoROF �
:���y � -
i
20- 20 D��f� 1� _
O�
I/ We certify�der the penalty of �flrjury ihat tlie above and foregoing infwmation is true and cortecl and Mat
Indiana and er oT Me aforem�r�tioned property on March 1, 20
y SignaUue (owners /ull name)
F addres f applicant (num6er and streeL dty, state. and LP oode)
. 2 N•�- �" � o r i ! e fdn r/J �/ J(c'7
Person authwaed by duy e:ewted Pwver aTAttorney or by IC 61.1-12-.07
pelsan (num6er and street. aty. sfafe, an0 LP oode)
was / were a resident ot
Date (man(h. dey, yea�