HomeMy WebLinkAboutMortgage_Miskell (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
• FOR DEDUCTION FROM ASSESSED VALUATION
• Sfa[e Fom 0.i709 (R77 / 6-09)
S � Presrnh4 M �epartnrerd of Lod Govemrtrent Fireixx
File Ma
INSTRUCTIONS:
To be fi/ed in person w by mad with the CourrtyA�ditor orCounry Recorder of fhe cnunty where the property is locat� � ��N'
Filirg Dates: 1) Real Property: Must fJe durirg the year tor which tha deduction is soughL �,
2) Mo6�7e /Manufactuied Homes rwt assessed as Real Pioperty: M�sl Ae during the hveNe (12) monMs �� �Ow Auditw
belore March 31 of each year the deduction is sought. � County Recorder
See reverse side /ar adCitional instnrcWns arM quzlificatrons. G IBS 0 N COUNTY AU DITOR
Ap owrerar mnflaU bl+yC/ - see restric8uns m rev/hB side) "
I . _ . r O n , l.!/ . �� _ . .� l�' n _ "
������
Ma�r�h 1. axmrt year
If ra, vfiat k ha / her eYaG share ot interest?
- l3 -.30 - /�� - oao. � _ oa
ge/ ContraiY intlehtedness unpaN as ot Matgage / ContraG InC
1. cvrtent Y� date oI aGPGntim
name on remrE's dMemnt Ihan that ol app&ant ctlicate Eelaw.
Name ot mortgapee or mnuad seAer
AddRSS W rtrort9agre w contrad seller (numbe�e si
Name of assi�ee or othu owner or Fwlder N mortgage
sfate. aM ZIP wde)
AGC oi assgnee (numDe� arM shee4 �+ry, state, antl Z/P catle)
� 7- [.� 30 - a- 9 5<I c
oces apd� ovn, wocem � a�y aner rc yes. wnat co�nryr
counrymlrW2re? n _, r-i ..
Drauction app�oved'c� tlre amount af:
20 _ � 20 _ � 20 _
� I.S�E Y
I I We certify under ihe penatty of
owner I tontracl buyer of the afor
�raa�re (o�meYs hd name)
that ihe
fesident edOress of appOmnt (numbererM stree4 dry,
20
awned wi� someone
Recorti numbrJ Page numbu
o/ s� 9 9
�mpaid as o( ISIhe appGvnt Ne sde
legal or equita6le avmeR
n Yes n No
IS CI¢ PfOP2f(yYl QIl¢SGOfI: MI1LL
❑ Real Pmperry � lvmua
MoWle
'_�-- '_'_�'—�
� Dra�r•er 1�'0.....°?��.�......
_ Card NO. ...5. ���.�.......
��
�:� �,9i3,�
20 _ � 20
yea�
20
P�'Y
nd foregoing infortnation is true and corteG arM that the applipnt is a resident of Indiana arW
date appiication is filed.
by IC G7.1-12-07
Mtlr�s o1 euthoraed person (numberantl sneeL ury, sbte,
Date (monN. deY.