HomeMy WebLinkAboutMortgage_Brown (2)*"�q STATEMENT OF MORTGAGE OR CONTRACT i NE oun Township Year �
_ • FOR DEDUCTION FROM ASSESSED VALUATI�� �j
� ^ Slate Form 43709 (R77 / 6-09) g JLJ
S�«. ° Prewibed M DeGarlmeM of Local Govemmenl Franre
INSTRUCTIONS:
NOV 27 2012 FileMark
To 6e filed in person w by maB with the Co�nryAuditor or Counry Recorder of the counry y�s�e ny ����, Fortn Aed wim:
F7irg Dates: 1) Real Property: Mus[ fife during the year Por which the deduction is wughf. - � County Audimr
2J Mo6Re /Manufactured Homes rrot assessed as Real Pooperty Must fi7e during the months
6efore March 31 01 each year the deduclion is sought. ❑ County Recorder
GIBSON COUNTY AUDITOR
See reverse sida for additional lnstrtrctions erM qualfiptions.
M (owrre�waontractbuyer- � � mrerersesede)
On�, �- .ly�,�.. � /i�,la� )
�
a
pfoperty as of
e�ct share oi intere
-�
Mor[qage / Contracl "vid
Marrh 1 artent year
��,tiaoo
name on tecord is ddferen[ Nan Ihat af eppWani, trMka[e below.
Name oT
Address oF inart9a9ee a contrad
owner w ImWer at rtprtgage
AEdress ot assignee (number ared SheaL a1}; 51ate, en0 LP code)
Dces ePpGmN awn propem/ in any oNer If yes, what wunty7
county m IMa�a? r-� ._ r� ..
7�7
SigreWre a(
20 _ � 20
a
RemN numbrl Page numbu
�vi a �"� s
6tedness unpaid as o( Is Ihe app6ont the sole
kgal w equfta6le amel!
❑ Yes ❑ No
spouse, mdinte with whom
Is ihe property in QuesUOn: MnuaAy Pssessed
�Ftea�arocer+v ❑lvmua�ywzsessed
Mobile Home QC 61.1-1
� � �35, a��
�. � �Q��,,..,...
� �pl•����er �0..•��� , .. „ �P�
❑ No
4UL l�•dl (� ��. ...........
i,
20 I 20
20 _ � 20 _
I/ We certfy undet ihe penalty of peryury that the above and foregoing intortnatlon is W a and cortert and that the applinnt is a resident of Indiana aM
owner I contraci buyer of the afo2mentioned pmperty on date application is filed.
FWI 2sitlent adtlress oIa{ryucant (numDer antl sLee(, ary, ffite, aM LP mae)
�- ,�,��y s, 7so, f. �i��,r��;s�o r,y y7GY
P son eutho�"ved Cy dWy ezewted Ptwer dAtmrney w by IC &7.1-12-0.7
Date (monN. tlaY•
Address of authoraed Ge� (numOeraM sLee4 �Y. slate. and LP code) . I /
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