HomeMy WebLinkAboutMortgage_Seifers (2).
^'+ STATEMENT OF MORTGAGE OR CONTRACT I��E� un 7ownship vear
• FOR DEDUCTION FROM ASSESSED VALUATI
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� State Fort1143709 (R71 / 6-09) g
�' �«. , Presa�bed M DePartment of LoW Govemrtrent Frexe
N0� 9 ZQ�Z FileMark
INSTRUCTIONS: F� fl� �:
To be filed in person or by mail with the CowryAUdifor or Counry Recorder o/ fhe county � located.
FDirg Dates: 1) Real Property: Must fi1e during the year (or which fhe deduclion is soug '' �uniy Auditor
2) Mo6Be / Manu(actured Homes rrot assessed as Real Pruperty: Must file dunng the J monNs ❑
beforeMarch3fofeachyearthedeductionissought GIBSONCOUNTYAUDITOR CountyRemrder
See ieverse side for addrtional insfructinns erM qualficatbns. � � �
o��a (/ �cey"�'e`��0
Ass�valueaf`rdW lasot Mwt�ag a/G
Matdi 1. acmnt yrar Mart3� 1. cum
tt ro. what is his / hu e� share of inte�est?
It rialne m fEtotd'a
Name ot morigasee w convati seAv
ar mntrad se�er (nuMcr aM sfree4
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Card NO: ... � �5�.....
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I I We cerOfy under Ne penalry ot p�7�ry that ihe
owner I mntracl buyer of the afwementioned pro
sbee4 �l; ���
prJmi (num0er arM stree; ary, sla(e,
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Page numbet
d I Is Ne eppfirent the sole
Iegal ar equtta6le omuR
❑ Yes ❑ No
awned with mmeone oNrl fhan spouse. kalicate wtth whom
State. aM LP crotle)
munly7 Whai Taung D'atricl?
couNtv nuortoa
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Counry
4s ihe propefty in quesGm: MnuaM �PSSeC
❑ Real aroperty ❑ lvmuanyAssessed
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requestea o� v�ro
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foregoing infortnation is We and mrtec[ arW lhat the applipnt is a resident of Indiana and
e appiiration is filed.
Date (monfi, day, ysan
y7
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