HomeMy WebLinkAboutMortgage_Knight (2).+"•* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ,
� � ColumB;R
State Fmn 43709 (R71 / 6-09) (B $ 0
S,w � Prescnbed by DePartmerrt of Loral Govertunenl Finance
File Mark
INSTRUCT/ONS: �
To be filed in person w by mail. filee tn:
Fifirg Dates: 1 J Real Property: Must 6e completed and dated in the calendar year /or which the deduction is sought. �/n rta
Must 6e (led with the County Auditor or County Recorder o/ the county where fhe property is located
on or be/ore January 5 oJ [he immediatety succeedirg calendar year. Recnrder
2) Mobrle / Manu7acturcd Homes not assessed as Real Property. Mus! file with the County Avditor o7 the C T
counry where the property is located dunng fhe hveNe (72) months before March 31 0( each year Ihe
deduction is soughL C ��
See reverse side for additional instnictions and qualifications.
Appicant(ownerormntraG6uyer-seeresmctror�s onravarsesida) GIBSONCOUNTYAl1DITnR
/1.i�. /J. c� rl 1• ;7 .� _ / %�. / ,�/ i.�T
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Maidi i, wrtent year
22 3�S.o0
tt no, what is his / her e�caq share ol
tt name on recard'a d'd(ermt Nan tF
Name ol
w mntraa seDer
-/y-[9^!03_000. y81-00�
Martgage / Cantrarl indeWedness unpaid as d Mortgage / Cantrad i
Marrh 1, artenl Y� date ot apdintion ,
or mntrad seiler (numbei arM sbeet, dry, 9ate.
. ii ii-ri
oi�er ovmer or
cade)
If owned wifh sameone ather than sPase.
ftecwd number Page number
oll ��fo�
unpad as W Is the applicaM Ne sde
legal w eq�n e(1
� es ❑ No
�Is M WopertY in Question: MnuaVy Assessee
eal ProperiY ❑ AnnuaDyA�sessed
Mobile Home (IC 6
Addr �ssign (n�mberantl sVge4 �l: state, and; l�'code) � . � / �" �O � �
N N�tJ q O. O
Does aPWipnt own property in any other If yes. what counry? What Tariy DistricT? Has thit dadumon been repuesled m poperty
wunryinlndiana? � Yes ❑ No ' __— W.oaren�veaY?__r-�_"__O'u�
COUNTY AUDROR l, � D I ,I ,
Detluctlon approved in Ihe amount of: L l�:l �i� �,' I� � �...
2� � 2� � 2�
Zo Zo. ca�-a ��o. .....�P.y�.....
�,�ry � i9v,ax�.�
i .o r- i.-.� .�
I/ We certify under the penal f perjury Iha e above and foregdng infortnation is We and corteu and fhat the applicant is a resident of Indiana and
owner / contract buyer of 1he aforementioned property on date appliratlon is filed.
Signature (ownels fiiC name� ,/% �, IClllI.TJZI / /�T//�� Date (monN. day. Yea�
L-!(¢iLCp
FuA resitlent address of applifani (number eM sbeet, dly, state, ZIP e) .
� 8 sz s �� so �. D,�I�.A,UD c„-� .�i✓ �%� 60
Person author¢ed Dy tluy e:e�vted Power of Attomey or by IC f.1.1-1211.7 —� � Date (monfh, day, yea�
Adtlmss of authoraed person (numbei aM street m}: sfafe,
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