HomeMy WebLinkAboutMortgage_Naas (3)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
; FOR DEDUCTION FROM ASSESSED VALUATION J
State Fwm 43709/R71 / 609) //
S Preuribe0 by Departme(n of Laal Govammenl Firence ��
ile
INSTRUCT70NS: �
Form
To 6e filed in person or 6y mail with the CountyAuUitor w Counry Rerorde� of the counry where the property is locat¢� c� �
Fi7'ug Dates: 1) Real Property. Must file durirg the yearlor whicA Ne deduction is sought V� T ` , Counry Auditor
2) Mo6de / ManuFactwed Homes not assessed as Real Properry: M�st fiie during the twelve (12J months
before MaicA 37 0( each year the deduction is soughG ❑ Cou^h Recorde+
�l . .
See reverse side (or additiona/ instrucLOns errd qualfications. l6� .
t(ownerarmnvartb r-seeresnlcnbnsmreversesile) GIBSON COUNTY AUDI
•' " istrk� Key rnimDer I kgal desaip6m Recorti nurt� P e number
a�- _o7-3od_000. s s_o�s '
Assrssed vahie cf real papeny az d A1mya ge / Contrau inde6te�'ress unOaiO as a( Morigage / Contraa iMebted�ms impaN a d Is Me a00�t e sde
M.arti� 1. ar'art yYdr Mard� 1. n�rtrnl year data W spPfKation �ega� or equita6le a�vnell
❑ Yes ❑ No
tl no, what is his / her e�Y shara of intemsl? tt ovmed wiM someone aher ihan spouu, IMirate wBh whom
II turt�e m remrtl's dAlerent Nan thai of aDP�m. ��� ce�' Is the property in Ouestion: MnueM AssesuV
❑ R� ��� ❑ 0.bdl�HOrt�e�IC 61.1-7)
Name W rturtga9� a mnttaC seAer �
A�dress W mortgagce or contraG seAer (number sbee; ray, stafe, ald LP cade)
Name of assignee or oMe� owner or hdder of nartgage
PAO of asv�r� (number aM streeS my. sta+e, e�d LP code) i O
SF T �'�-�o ,�3.4-c Di-a�ti�er\0.��•�..........
i
Dces ePWinrrt wm {voperty in any other If yes. what count/� What Tadng Da[ t/ I O�
munry in Indana? -
❑ Yes ❑ No C�1'(i �O . .....................
COUNTYAUDROR .
Drducaan appfoved in ihe anounl oE
20_ 2p_ 20_ 20_ 20_ 20_ 20_
� nanne oi CamtY Aueitnr Counry Date (rtnrtlh. Eal: l��
� I I We certify u ihe penalry of perju that Ihe above and foregoing infortnalion is We and cortec[ and that the applicant is a resideM of Indiana arM
owner I contraq buyer ot Ne aforeme ' ed properry on date application is filed.
� (ownefs MI r�erne � Date (nmfi, daY. Y��
Fup resident ad�es W a� i number and sLee4 m}: sb1e, and LP e)
(� 3 a/ S. !�'r i n � e- s � c e1�o 1 ��%6%O
PrJSm autlmmed Gy duty executetl Prnwer o( Atmmay or by IC 6.1-12�.7 ua�e (mw+u�. der r�
Address of aW�wae� person (number arM streef, rif}; state, en0 LP tode) . �
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