HomeMy WebLinkAboutMortgage_Vincent^�n STATEMENT OF MORTGAGE OR
, , � FOR DEDUCTION FROM ASSESS
� StateFwm43709(Rtt/6-09)
�' �.,. 1 Presvibed by �epartmenl of Loml Govemrtrent Flnanp
wsrnucnoNS: MAY 1 O 2011
To be filed in person w by mail with the Co�nry Auditor or Counry Remrder o7 the wunty where the property is located.
Fdirg Dates: 7 J Real Property: Must fJe durirg the year for which the deducfion is s�.
2) Mo6de / Manufac[ured Homes rrot assessed as Real Property Must h7e dunng (12) rtwnths
6efore March 37 0l each year the deduction is sought.
See reverse side tar edlfitanql instrucGons aM qualifications.
GIBSON COUNTY AUDITOR
�,�d�,�,��
curent year
Whd16 hi5 / I�M 0%2Cf Sh310 011f11PlP3l?
i:L
Nama ot rtextgagee a mntraa
r aiaes [ron RecoN
�- �a.-07�0/-bD�. �Sl --aa�
e/ Contraa "udebted�ress unpaid as W Morigage I Contra�Y iMebteCness unpaid :
Memh . artent year �� Eate of aDP��
If OVTBd Wlth SOl11EME ONM CNlI SGW50. IIIdW3l81
Address N nnrt�age� n contrad seder (nurriber and stree4 �: s+ate. aM LP code)
Name of assi�ee or Wre1 wmer w holder d mort9a9e
Aearess or assignce (nurnber erd aneet �: smte. arM zIP code)
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COUNTYAUDROR
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Counry
File Mark
Fwm fJed with:
��Counry Aueimr
❑ County Recordu
Yes LI No
Is me wovem m Qu�,: a,m,eM nsseska
❑ Real Pmpeity Q MnuallyAssessed
M1bW'le Hane OC 6
�h¢ deduCim Eeen requeste0 m pioperty
iment Year r-i .. r-�
� ��
Oay,
1/ We certify urWer the penalry o( perjury that the above arW foregoing infamation is true and cortecl and ihat the applinnt is a resident of Indiana and
owner I contracl buyer of the aforemeryhu�ed property on date appliratlon is fileA.
Pason autMr¢etl Ey
state, antl LP ootle)
Power of Atibney a Oy IC 61.742�7
parson (num0er a�M sbee; cay, sbte.
�ace (monN. EaY. Y��)