HomeMy WebLinkAboutMortgage_Rose (3)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n Township Year
_ • FOR DEDUCTION FROM ASSESSED VALUATION
� smce Fom, aa�os �i� i s-as�
S � Presrnbed M�Pa�rd o1 L.ocal Gwemmerd Finams
File Mark
INSTRUCT70NS:
To be fi(ed in erson or b mail wiN the Coun Audito� or Coun Recorder o/ the coun where the io JA m
v Y N b N a aeM is rocated. '
Fifirg Dates: 1 J Real PropeRy: Mus[ 67e during the year (or which the deduclion is sought. � Counry Auditw
2) Mo6De / Manufactured Homes lrot assessed as Real Prnperly: Must fife during the hveNe (72) months/]/ .
6efore March 31 of each year the deduction is sought �((Qj� e�e�
GIBSON C
See ieverse side for addrtimnal instructions end qualifications. AUDIT
IM (o�merwconvaCb^uyn/i�'see mreverseside �
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Ta�a�g � Key num6er! kgai desoiption R¢cpiy num6er Page nu
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Ass�ed rdue d rral pmpejly as W Mor�age/ Contra¢ 4dehtedness unpaid az ot Mortgaga / Convap inde6te0ness unpaitl as d Ls Ne epp�rant Ihe sole
MaU 1. aa�ent yrar Mard� 1. cvrtent Y� date of aPP�tim� � �� kgal a eWita6le awne(1
LOiJ.O�� ;YT()!JU ❑Yes ❑No
i 110. Wh2I IS h6 / hPl ¢YdC Sh2lE 0( II1ICRSE?
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se0er (num6rl ard sfreeL uN• ��.
Nama of astignee w othrs wmer or hoidu M mort�age
Address ot
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any oNU If yes. wha[ county.�
Yes n No
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NTat Ta�dtg DistriC7
IS ShC DroOeKY 1f1 VUCSG011: M(W0�`/ /�
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N's Eeduaion Eeen requeste0 on propeny
urtefnY�' r-� .. r-�
ducuon aPw�d in the anwunt at � l�a 1ti'
er i\'0.�. � �o�........
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cat-d �vo. .. ��3'7 .
n»wred ryawrt« . � Counry � �f(�•�•�••y� . ...
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I I We certiy ulWer the penatty ot perjury that Ne above arW foregoing intortnation is We and correa ar�d that the appiirant is a resiaem u� ..�_.._
owner I contract buyer of the aforementioned property on date application is filed.
Pr�sm authatretl by
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AtmmeY w by IC G7.1-12-0.7
of auNor¢ed 7P+� (num6er antl stree4
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