HomeMy WebLinkAboutMortgage_Pancake (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yea
_ FOR DEDUCTION FROM ASSESSED VALUATION
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1 � PreuriEeE by Depamnerrt af taral Govemmeirt Fuiarra
File
INSTRUCTIONS: � � �:
To 6e filed in person w by mail with Ne Caunry Auditor or County Recorder o/ fhe county where the property is located.
Fifing Dates: 7) Real Property: Must file dunrg the year tor which Ne deduction is sought. �}{� Auditor
2) Mo6Ae /Manulactured Homes not assessed as Real Properly: Must h7e dunng Me Rvelve (72) months Q T �nry Recorder
6e(ore March 37 of each year the dedud"an a mught.
See reverse sida for additional instnxfions and qualificatmns. � "��� y y,
I Ap�ant (. oontrart bN'er - see rpstrirtars m �c side) L 1 n �
�,�d�,���
MmU 1. anW year
H no, whal Is NS I trer eraC share Of intemstt
li IIMiB Ofl fOCdfli 6 Qi:Mi.YII Mdll �hdl Oi 3DP�
r / legel drsaiption
��-�a-�g-zaM - �
Mpr(q�ge� cono-acc irdemea��s ��cab as or
A1emh 7. arten[ yeer
rtprigagce or contract se0ei (number erd street cdy, aafe, aM LP taUe)
rvame m asvgnea w omg owner or naaer m mory�aga
vaeresa o, assgnm �numner ano sueec wr smre.
Dces ePplipM am p(openy in any otha
munry m InEana? r—� .. r-i ..
the amount ot
It yes. wna[ munryt `
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GIBSON COUNt r Nuv�����
Recortl numEar Pege wmber
___.___ _ ..- - .. . I
legal a equipNe avrtwYl
❑ Yes ❑ No
spouse. "uW'xate wM� vArom
,�}s N�¢ pfOpCflY ill GUCSSIOfI: MIWaO`l A�SE55CE
�nC31 PmPeriY ❑ NmUaIIyASSe�d
oeoale �iome nc 6,.,-:
D�'a �rer �\,�
...�la
�a`�� !�`o. .....�7yc��..� ..
� ��3,ova .� � • .
��D�Y
Yes ❑ No
2p _ 20 _ 20 _ 20 _ 20 _ 20 _ 20 _
naw�e w caum a,ertw c«nuy oate (�u,. ear rean
I I We certify ufber the penatty oi perjury that the above anA foregoing infortnation is true and cortecl arM Nat the applirant is a resident o! Indiana alul
owner / wntract buyer of the afaeme�rtoned property on date appiicauon is filed.
i^?tG� (ownefs NO^aTe) � n Date (nmM. daY. Yeeh
a�W
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i�eison awiaf"ved M eWr e:ecureo rowri orAam�ey «M �c s�.t-�z-0.�
AdCresv of autlmr'ved De� (num6ereid sbeeS �Y• ��e, aM LP code)
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