HomeMy WebLinkAboutMortgage_Pegram^�� STATEMENT OF MORTGAGE OR CONTRACT IND Township vear �
_ : FOR DEDUCTION FROM ASSESSED VALUATION���
' sraca rbrm.u�os (a„ i s-oe)
�' �. � Presm'bed M OeP��M af L.oral Gavemrtrefd Frunce
File Mark
wsraucnoNS: NOV 2 9. 2012
To be filed in person or 6y mail with the CowyAuditor orCaunry Recorder o( fhe county where th@ prope is located. F� �� ���
Filing Da[es: 1) Real PropeRy: Mus[ file during the year Por which the deducfion is soughL C. J. ,� Counry Audimr
2) Mobde / Manufactured Hortres not assessed as Real Property: Must fife dunng the tvmlve f ths ❑
6efore March 37 of each year the deduction is soughG - Counry Recorder
See ravarse side foradd"rtional instructbns end quaGfications. GIBSON COUNTY AUDITOR
a�
Msssed rahie d real piapeny as of
MarM 1. ammt yrar
Key nvn0er / legal desaiPtion
-/$- O -Cd � , %� � - C�
Mor�qage/ Contract'uWehtetlness unpaid as of Mortgay
Mard� 1. wrte�rt Y� date of �
i M. NfiB� IS h6 / hPlOYdC 51WE Oi V11CRSi?
tt narna m rectttl
rtnrtgagee or mntraG seller � � R
_'l
of mortgagee w mntract seller (num6er end stree{ cdy, stdte, arM Z/P code) --�
Nama ot assignea or
Adaress
mortgage
Does ePplirant own pmperty in any oNer I I( yes, wha[ munt7/7 I Wtui
counryinlMwia? ❑ Yes ❑ No
icuon approved'c� the artrount aE "
20 20 20 20
Reco�d number Page numbel
a 5a 5
5s unpaid as of 4s t�e appfimrt the sole
kgel or equitaWe ame�?
❑ Yes ❑ No
a. rt�dicate w1N whorn
propelty in V�6GIX1: M�weP/itssesSed
eal PfopertY Q Annuaily Assessed
MoWle Home QC 6-1.1-�
�"_
�Y� 15'CI' 1�`�, .�0 �� ...
Cal'd !�`O. , �� I •.
_ /. .i. ��G.��.•Gd..
�
20
Qate (nrmth, daY.14a�
� �,
❑ No
20
1 I We certfy under the penalry of perjury that the above afM toregoing infortnation is we and cortea arM that the applicant is a resident of Indiana and
owner I mntract bttyer of ihe aforementioned pmperry on date appliration is filed.
ifawre lovmers NO nemel �. Date (monN. daY• 1'ae/)
Pelsan
prlson (numEerarMSbee;pry,sfale,aMLPmrle)
�
'��'
1�