HomeMy WebLinkAboutMortgage_Garbers (2)^'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. � FOR DEDUCTION FROM ASSESSED VALUATION
� • State fam 43709 (R71 / 6-09)
•'„�. ° Presrnbed M DeP��N o1 Local Govemrnent Frunce
File Mark
INSTRUCT70NS:
To be fJed in person or by mad with the CountyA Witor or Counry Recorder o! fhe counry where the property is located. �
Fr7'vg Dates: 1) Real Proparty: Must tle dunng the yea� for which the deduclion is sought. � �y q���
2) Mobde / ManufacNred Hanes rrof assessed as Real Prtiperfy: Must fiie during the hvelve (72) months ❑
6efore Mardr 31 o)each year the deduction is soughG - n ecorder
See reverse side /oraddrG'or�L�nstructlons arrd qualificatbns. ` GIBS
MWm�� (owxror contraC yyer ue resfictions m re"xrs5l�e) /"� _ , n �
P�Y �
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m remrd's 6Rerent Nan that ol app6mm, trdidte below.
Name ot mort9a9ee or
� Record numher Page number
� I{/V�OOO�r� D��O�CS�
4Mehtedness unpaitl as af Morlgage / ConvaG'uMe6tedness unpaid as o( Is Ne applinnt Ne sole
v � tlate of apP�� legal w equitahle ame(1
/ � (� ❑ Yes ❑ No
Add2ss ot rtnrcgagee w contracl seller (number aM sbee; ciry, stafe, arN LP code)
or othu owner w haldar of rmtgaga
otas9gnee(num ' ., /�' . JOO. W
Fi
rc owned wim someorre omu ttan spouse� indimte wim whan
Dces epplipnt rnm pfope � n Tarin
counryinlndiara? Dra���er NO...:�� a�. .
..�.... _
I C1 �� �rzoR
���,��m� Card NO. . � .............. —
zo
syrewa
ca�
zo
Ls ihe ProP�Y in question:
❑ Real FoPenY ❑ p
Has Ihis deduction been rcQUested m PropeRY
for artent yeaYl � Yes ❑ I
zo
w�
zo
I I We certify undet the penalty Ot perjury that the above and foregoing infortnation is We and correc[ arW tha[ the applicant is a r�esident of Ind�ana aM
ovmer I contrad buyer ot Ne aforementimed property on date application is filed.
i e/s hID n�rm) /� . Date (monfh, daY Y�8�)
' L "� `7l��
app�nnt (numDerenE sbee4 dty, state, arM LP code)
authofaeC Cy didy exewte0 Powet of Mvney w by IC E7.1-72-0.7
Adtlmss of auNaaea p�son
Date (manfh. deY•Y��
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