HomeMy WebLinkAboutMortgage_Lienemann^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBT.EDNESS Township Year �
.__ .• FOR DEDUCTION FROM ASSESSED VALUATION II� �� J�
� Slata Fam 43709 (R11 / 609) �
�` Presaibed Ey DeP��M o1 Laal Govemment Fuance
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INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor or Counry Reco/der ol the
Fitirg Dates: 7) Real Pmperty: Must file durirg the year for which the deduction
2) Mob�7e / Manutactured Hortres rrot assessed as Real Property
6efore Maich 31 oI Bach year the deduction is sought.
See reverse side /or ad�i(�onal instructions and qual�cations.
n
AooG�ant(ownerwcon r-see onre ^sidel l
f�
II �a. what is his! her erar�
nane m
Name of mortBa9ee a mntraU Seller
��T 3 0 Z��2 File Mark
county where the ProPertY fs bcated. Form filed wim:
is sought. L.'�. n`°���—� �, County Aud'rtor
Musf file during the hvefve (7?J months
v ❑ Counry Recorder
GIBSON COUNTY AUDITOR
- �-G�/.3�oZ -Zbz / _._ ..��-.._
�a�G'uWe6teaness unpaid as of Mongage I CantrarY ifWebtedness unpaid a of Is Ihe apptirvnt Me sale
�� tlate of appliqliwi legal or eduitaWe o-xne(.�
O Ll l� ❑ Yes ❑ No
tt awned wiN someo�re other than spouse. iMirafe wuh wlwm
Pddress of nwrcga9ee w mntrad u0er (nuMer end sbeet, cdy, state, and ZIP code)
Name af assignee w other owner w twltler W mortg
A44ress ol assignce (number eM s1ree; tlry, state,
Ooes aPW�t own property in any oUer
munry in Indiana? ❑ Yes
❑ No
Deduction approved'c� �he amount of:
20 _ � 20 _
Is Me DroPertY in question: MnuaOyAs,esuV
❑ Real ProPenY � ��N�
LPCOtle) ' �' . .
t . •
� � , ola......
irres..�,,aca et- \o..:......
� 1':1\Y.
C'll•(] \Q. . ..V . J.�.�•.....
�aa:$.;93�.�?, .. :
20 � 20 � 20
�v , i i /w i..
I I We certify unCer Ne penalry ot perjury th the above and fo
owner I wntract buyer of the aforemenlioned property on date �p
$ignawre (owne(s hm name) .,
�C �' q
�`�ey�o a I(n O^! erd 5hee4 , state, and LP md
'" 1 \ `�-�1- -�� 1„��r�.�.....
Pason authaaed 7y duy ezewtetl Power af Attomey or by 1 6�1-12-0.7
person (numberaM5Lee4�Y.sfafi.anOLPmtle)
Couny
�uGirn Eeen requested an pmperty
Ye� ❑ Yes ❑ I
20
Date
20
infortnalion is We and cortect and that the applicant is a resident of Indiana arM
ion is filed.
Oate (rtrnth. daY. Ysa�
Date (month. daY. Y��