HomeMy WebLinkAboutMortgage_White (5)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN� oun o hip Year
__ , FOR DEDUCTION FROM ASSESSED VALUATION
• � . State Form 93709IR71 / 6-09)
�' ,,,, PreSrribeE Ey Departmerd M laral GovemmeM Frence �
wsrRUCnoNS:
N�� 1 IeMark
Fortn hled wiN:
To 6e filed in person w by mail wifh the CountyAudita or Counry Recorder o( the county where the property is located.
Filirg Dates: 1/ Real Property: Musf file dunng the year (o� whirh Ihe deduction is soughL `�jj d ,� � County Auditor
2) Mobde /Manufadured Hanes not assessed as Real Pioperty Must Sle dunrg the hvelve (12f montlr �
6efae March 37 0/ each year the deducdon is soughG County Recorder
GIBSON COUNTY U . R
See raver,SF side !or additiona/ inshuctions antl qualifications. �
d
fR.T^i!'%�
tt ra. what hs ttis! her e�ma shara of interest?
o- � �- vv i�
�. / Conbaa indebtedness unpaiE az of Mort
wrtent yPar date
If �rtie m remtl e Wrterent than ihat of aPp�aN, NCicate bebw.
Name o( �a9ee ar mnuaG seDer
contrad seller (num�er aM stree4 c4y. state,
(rwmber and stree4 mY• sm�e. arM LP cade)
Ooes epplifant am pDperty in any olher I If yes. what munty.+
munry in Indana?
❑ Yes ❑ No
� i � i �
nuertor
- Qa 2� os a � 0 4� y'd,J
onfracY i�Webtedness imVaid as d Is tlre aP�t Ihe sde
�tion �1 n �(7� legal a equitade ame/?
�7 /h/CJV ❑Yes ❑No
tt awned xiM someo� oNer than so6use. udiraie wtrh whom
I5 tl�E D�DeRY in question: MnuaDy Assested
IblReal RoPenY ❑ ��!�Y.�
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C�i.d \Q. .......... �
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^r° �r�m. dar. r��
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,I I We certity under Ihe penatty of perjury Nat Ihe above and foregning intortnation is We and cortect arW �hat ihe applicant is a resident of Indiana arM
owner 1 mntracl buyer ot ihe afaementioned property on date application is filed.
� SiBradre ( ) � � Date (nmth. daY. Y�
� Full resident addfes U t(numDe� ard sLeet �: sb1e. Z1P mtle)
�� oZ � J U 'z°
Pvson autlwlizetl by OWy etecuteE Power o(Attorney w by IC 61.1-1 �.7 Date (/+ron�h, d2Y. Ya�
Atldress of aWror'¢ed person (numberaM sbee; dry. sfate, and ZIP code) .
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