HomeMy WebLinkAboutMortgage_Freeman'^� STATEMENT OF MORTGAGE OR CONTRACT IND�$��SS Coun Tovmship Year
:._—
< FOR DEDUCTION FROM ASSESSED VALUATIOI�..�'
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,�' ! p�'hed by �eP��M of Lnmi Govertunent Frianre
File Mark
wsrRUCnoNS: NOV 15 2012
To 6e filed in person or by mail with the CowryAUditor or Counry Reco�der of the counry where the pm rty is located.
Filirg Dates: 1) Real PropeRy: Must file durirg fhe year lor which the deduction is soughL C��.
2) Mo6Be / Manufactured Homes rrot assessed as Real Pioperty. Must file dunng the fwe (1 nths
beforaMarch3foJeachyear[heAeductionissought. - GIBSONCOUNTYAUDITOR
See reverse side /or addifiWnal inshuctions arM qualifications.
(awnerwcont2d 6vyer- sp� resMra'or� reMrse siie)
arth 1. aa2n� lmar
m. what is his l lres eract shara of interest?
Fortn Aed with:
County Auditnr
Counry Rewrder
tl CesaiPtiwf Reca�d nurtfDtl P e nuMer
31 -�363-oa� •.376 °O aoi� ,�.3/
3ge/ Conbau 4dehtedness unGaid as ot Mongage / Contraci IM unPaid a d Is ihe ePPfirant the sde
1, wrtent yrar date of appOCation legal or equitaEle oxnell
� ❑ Yes ❑ No
tf ormed wi� someona aUre1 ihan spaae,'udNate wlth whom
If name m recad'a dMemrt Nan that of appOrant, hMfn1E 6ebrr.
Name W nnrtgagee v contra�x
contrad seAer
w oNet owner or hddu of mortgage
Is the Property vm QuesGOr� MnuaoYASUSed
� Real ProPeRY ❑ Atatually Pssessed
AEdmss ot assignee (numbrs ard sLeet dry, state, eM LP code)
Drawer NO..`���•°�i........
Dces ePplimN own property in any oNer I( yes, what munt�t What Tad �7 rty
munry in Indara? ❑ Yes ,✓, � i..L .
❑ No
Ca^r�d NO'.1 .... ....... —"°
COUNTY AUDROR ��Y�I p f/� �1� O'.✓iQ •� —
Deduc6on approved'u� the amount o1: 445� �q �'b( V
20 _ � 20 _ � 20 _ � 20 _ � 2U _
Counry
20 _ � 20
Date (month. daY•
ertify under Ihe penalty of perjury Ihat the above and foregoing in(ortnation is true and cortect aM �hat the applipnt is a resident of Indiana a�
mntract buyer of the aforementioned property on date applicalion is filed. ��
�w/er3 fy� rmme) trdte (monfi, daY. YaeA
sbeet, aTy, state, and LP mtle)
aut)araetl by dNy exew;ed Fburi of Aimrtiey
IC G7.1-12-0.7
Pddress of aWw"¢etl person (numDe�arM sTeeG �; stete,
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