HomeMy WebLinkAboutMortgage_Gibson (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T ip r
_ � FOR DEDUCTION FROM ASSESSED VALUATION
. .. .• State Fo+m 437091R71 / 6-09)
. S�.p s p��bed by Oepartment of locai Govemment Fnance
Ftlt�A/erk
INS7RUCT10NS: ��C�'
Form filed wiN:
To be fi/ed in person w by mad wiN the CowrtyAWitor or Counry Remder of the county where the property is located.
Fdirg Dates: 7) Real PropeRy. Must fi7e during the year for which tha deductlon is soughl. �' Cou tnr
2) Mo6i/e / Manufactured Homes not assessed as Real Prnperty: Musf fife dunng the fweNe (12) months n
befae March 37 of each year the deduction is sougbt GI SOFCOUN n er
See reverse side fur additional instrucWns and qc^'�fications.
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7 CYJ �
Di:Aia / kgal desai tion Recortl numha Page numbrl
� �-�a-o�- a - o��.�Q�-oa�' �
p� � o{� pop�y � of Mwyage 1 Contra� Indehtedness unpaid as o( Morigage I Con�aUU Indebtedness unpaid as of Is Ihe apPlinnt Na sale
A4arti� 1. ar�art yrar Ma�� 1, curtent Y� date of aPP iegal w equitable amrll
❑ Yes ❑ No
Ii fq. whai fs his / Iret 8Yffi sharc Of interesil 1/ axTed wiN sameone Ihan spouse. iMiCate r5ih whom
tl name m remN a GRemnt Uun Nat of aPP�L'o�dkate hebvr. I5 Pmperty in Vuestion: MnuaM hssessed
eal (hoperlY Q ArmuallyA55essed
MoWle Fbme C 61.1-
Name of mortga9ea or contrad se0e� n/
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Add2a of mort9a9ee u m+ben srAer (mm6e� and s0ee; rity, s�, ard LP wde)
Name of assignee or o�har wme� or halder af mortgage �-
Mdress of as�9nee (number arid stree; tlry, sta2e, and LP code) ' u n 1 I(�� _�
Zi ,� J ��
Dors ePplicant own propem) in anY oNU If yes. wha[ munt�/1 What Ta�drg Disl (/��j�
counry m IMfara? ❑ Yes ❑ No . . : • k-!� � • • • ••
Dl•a���cr �0.. .
�o��,�A�oROR 5a�1 �....
DeCuction aPP�� In tlie amwnt of. \ O , . . . . . . . .
C�►�d
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sgrcawre d cmmN nwnor CamN oate (monte. dar. yea�
I/ We certfy under Ne penalry of perjury that Ihe above aM foregoing intortnalion is W e and cortect and that ihe applirant is a resident of Indiana arM
owner I contraU buyer of the aforemerrtioned property nn date application is filed.
� Slg , owneR hAname) Date (montlt. day, yea� .
� FWI ' ent addrea oi appGcant m6et a t, tity, sfate, arM LP code)
Ps�.,on authoraeE by duy executetl Power af Attm�ey w by IC 61.7-12-0.7 �� (�+�. �Y• Y��
Address of authw'ved person (number an0 sLee4 �+�Y, sfate, end LP code) . •