HomeMy WebLinkAboutMortgage_Hicks (2)� STATEMENT OF MORTGAGE OR CON DEBTEDNESS
:�_,_ • FOR DEDUCTION FROM ASSESSED ��T�pN � �
Sfate Fam 93709 (R11 / 6-09) �
S,w Presm"be0 by Depar[ment of Local Govemmenl Friance
Coun Township Year
File Mark
wsraucnoNS: SEP 19 2012
To be filed in person w by mail with the CountyAuditor or Counry Recorder ot the counry where the property is located.
Fi('mg Dates: 1) Real Property: Must file during Ne year for which the deducLnoiis�s6�f.�y
2) Mo6de / Manufactured Homes irot assessed as Real Property: Mus[ file�n�g.[he nvelve (12J monfhs
6efore March 31 of each year the deduction is sought.
GIBSON COUNTY AUDITOR
See reverse sid�e�7or additional insWCtions arM qualificatbns. �
Aoofi�nt (o or buY r see_ on rerErse sidel _ �q _
�
!y'r,:�
Form filed wkh:
i�l CountyAuditnr
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❑ Counry Remder
Key rvanber I�al descri� �� � 7- 3� 3-C� dS 8-�S RemN numbe� Pa9e numbu /
V � O
Mwtga9 e/ Co�c InCebtedness unpaid es o! Mortgage / Contrafl inde6tedness unpaid as d Is Ihe epplirant Me sale
Mard�l.ars�ephcl/�war�O� EateofapPliption legalor❑Y�eame!?
/ry ❑ No
dtlFerent Nan ihat of aPpGrant ��te Eebw
Name m mortgasee ar m,vad sWe. /
l
Address of rtart9agce et mntrad sr�er (numbereM sLael
�
� �-�KS �A�E.-rD
' A-N6t1A
i�-�.83i
20 _ 20 _ 20
ciry, state. aM ZIP oode)
lunp? N/1121 T3vng DiStriG?
COUNTYAUDROR
20 20
Is the property in question: MnuaOy Pssesse0
❑ Rea� Property p rw,ua�y acsessea
Moble Home (IC 6
Ihis tleCUfYim bern re9ursted m P�Y
wrtrn Y�n r-� _ _ rl .
20 _ � 20 _
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I/ We certify under Ne penalry oi pey{�iry that the above ar�toregoing infortnation is we and correct arM Nat Ne applicant is a resident of Indiana aM
owner I contraa buyef of the afaemeMimed property on b�:e application is filed.
^� o�e,y � rta�'� � Date (rtnntA daY• l'ea�
.J V, � �1
9 revdent ` o( appGrant (number antl sheef, ol}; state, aM ZIP e)
D N�.� .iv. �;,�, �,•�,. S-1 Y�4n�,t��, z�✓ ���5�9
Power o(A[tomey or by IC 61.1-12-0.7
authoraed person (numberantl s0ee; c4y, state, and ZIP oode)
oa�e cr�rvn. a�r. r��l
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