HomeMy WebLinkAboutMortgage_Kern (2)ry� STATEMENT OF MORTGAGE OR CON��B�N�SS'J Coun 7ownship Year
� FOR DEDUCTION FROM ASSESSED VA A t JJ,y
, State Fwm 43709 (Rit / 6-09)
. ,,w � presm6ed by DeD��N af Laral Govemment Fnance
�srRUCnoNS:
OCT 12 2012 File MaAc
�� Fwm Ned wNh:
To be fAed in person w by mail wifh tAe CountyAudiror o� Counry Reoorder of the_taiudy whE2�the�propeRy is located.
Fdirg Dates: 7J Real Pmperty: Must file dunng Ne year for which the deducfion is sought. v �� � Cqunry Auditnr
2) Mo6Re / Manufectuled Homes rrot assessed as Real Property: Must file dunn9 edvs/ve�(12) monfhs
6efore March 31 ofeach yearthe deduction is soughG GIBSON COUNTF ��u� � �� ❑ Counry Reoorder
See reverse side /or eddiWnal instnrctions arM qualfications.
AppSesnt (owiws or oq�0aa b✓Y�� - see m�' "wu m re � e) '/ �
� I n.11 m Il � A_nn �1 \.on nr�
A� vdue of 2al
Marti� i, aarem year
Key nimba! legal desaiPtion
a�-i�-z9-tiav Qoa.3aU ��S
d MMpape / Conbaa Indehte0ness unpald as of Mortgage I Convari uMi
March 7, artent year date o/ appGtation
It no. what ts his! her exact shara o( u
If nartie on rerntl'a 6Rwrnl than Na
Name ot mortoaaee or mntrecl seller
w mntrad se�er (nwnb� and sveef, �dy, sbte. ard LP code)
W assignee w other ovmer
Add2ss of assgnce
Ooes applifant qm
munty m Indana?
�
DeduGion apWweG
20
(number antl street dry, sbte, aM LP ootle)
uoperty in any other If yes, what muni�/.+
❑ Yes ❑ No
u� Ne amount oE
20 � 20 _ � 20
legal w equirabie wmeY?
❑ Yes ❑ No
wrth xlnm
Is Ihe pmperty in Vuestion: MnuaDy Pssessed
❑ Real ProPeKY ❑ %!�^!!�Y.�
K�, 3oN N �
WhatTadn \ ' .�C.� . /�
�,y__�� f'S
4UDROF 'a�, �� U
20
(nwnHt. daY. Y��
nY
� Na
I/ We certify under the penalty of perjury Ihat the above and foregoing infortnaUon is Vue and cortect ark Na[ the appliran[ is a resident of Indiaria and
owner I mn ct buyer of the aforementbned property on date appiintion is filed.
�/ � /F / �(/V L Date (monfh. daY• Y'��
%�6Sr S `+'s'v
auftro�¢e0 M' dWy exewtetl Pow
sbee4 dN, �te, eM LP cade)
�✓ Dt„�n s.�� !�>_ , .�iv �i% %
person (numbe`an0 sbeet, riry, sfate, and LP cvde)
o�,�. �