HomeMy WebLinkAboutMortgage_Obert^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
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• FOR DEDUCTION FROM ASSESSED VALUATION
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S � p��iy¢d by �epartmenl af Local Govemment Friarce
INSiRUCT10NS:
To be fi(ed in person or by maiT with the CountyAUditor or Counry Recarder o! the oounry where the property is located.
Fditg Dates: 7) Real Property Must fJe durirg the year for which the deducfion is sought.
2J Mo6de / Manulaclured Homes Irot assessed as Real Property. Must file dunng the twelve (12) months
befora March 31 01 each yea� the deduction is saght �
See reversa side /or addifional instrucGons arM qualificafions.
APa�ca�i(ownf�9<<fP�fbuyel'seeresmcmns�mreversSfidB) . � .n �. w �
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p1 !¢COfd i5 3Af¢7¢!It Nan Nat o( aPP�t �W�fa bEIOVl.
Name W rrortgagee or contracc se9er ./�
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Mdress of rtwrt�a9ce w mntrad seDer (num6b'.r end sLee; crty, slate, aM 2
Name of assi9nee or other owner or hdder of morigage
Mdress oi ass9nee (numberarM svee; dry, state, arM LP cade)
o�oPS epp�imnc wrti v�cem �^ arir omer rc yes. wnat m�neyl
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Deduc6on
Fam file0 wifh:
D� ��1a,��
GIBSON COUNTY
npaid as of Mwigage / CantrarY indeMedness unPaid as d Is Ne aPPlirani Ne sok
date of applimtion legal w equitable omwYl
❑ Yes ❑ No
tt awne0 someone other than spouse. hWkata w(ih wlrom
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Is Ihe praperty in QuesGOn: MnuaDYASSessed
. ❑ Real ProPertY ❑ ��Y �
Mohle Home (IC 61.1=
2� _ ( 20 _ I N1 I Z� _
s�rewre a ca�,N a,a�w�
I/ We certiy urWer the penatry of perjury that the above and foregoing infon
ovmer / Sontract bUyer of Ne aforementioned property on date ap�cation i�
Kill re�tlemfEtlress W app�rcant (n�.mner ana slreeWry, stare, arid zlP m
/ ,
authofaeE by duty executed Power o( Attomey w by IC 61.1-12-0.7
AdCress d auNOrizetl person (numDer arid sbeet �}: s+ata, end LP cade)
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AUDROR
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E R�c k A
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2quested m PropertY
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