HomeMy WebLinkAboutMortgage_Brengman •
q
?� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coon • Township Year
ly,: FAO D C�Tlb-CS)FROM ASSESSED VALUATION
:m Presmbed Dy Department of copra Government Finance ' '' :''.
INSTRUCTIONS:
IF ' f �
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly Is boated. Farm Rea
Filing Dates: 1)Real Property.Must file during the year for which the deduction is sought ()E C 2 8 Z 12 0 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(1 maiths , County Recorder
before March 31 of each year the deduraon is sought _
C_9.m. .
See reverse slate for additional instructions and quaff+atbns.
Aov[m+t(owner orr contract tbbuyer-se ram ' reverse side) GIBSON COUNTY AUDITOR
T ' Du!. C.-`Keeyy comber/legal description .Retard number Page number
f , ato - / A - 05 - la3 - cn y . zz5-0a8' 1 / 2. 3y4 -7
Assessed rake of real city as of Mortgage/Contract bdehatness unpaid as or Mortgage I Carmact indebtedness unpaid as of Is the epgimat the ate
Maim I.anent wear Mares 1.cvnent wear I dax WWI wt+m legal or equ
of ihLG awnell
2 900 ❑ Yes 0 N
If no,what is his I her erne shore of interest? If owned with someone other titan spouse.(ndcate with whom
U name on record is dderem than atat of appecent b oa bow.. Is`tc m mambo&/Warn Assessed
J'R arty ❑Annually Assessed .
Mobile Home(IC 6-1.1-7)
Marne of mortgagee or contract saes r /3
Address of mortgagee or mitrad steer(number end street.city,shat,and ZIP code) -...
Name of assignee or other owner or holder of mortgage BREOG "'4M TTytE72. —
Address of assignee(number and cleat.dry,Ya:e.end ZIP coda) •a R+U��u`"
Does epplimnt or property in any other U yes.Mar-at county? -WhaI Tang
I R- • 6 / sty
rounry Inn tnd'au? ❑ Yes ❑ No
No
COUNTY AUDITOR - • •- — -
Deduction approved N the amount o.`. ..
d
•
20__ 20 I 20 20! 20 20 20
signatum of Cauny Ar jer County Data I1rmtt.day.Year)i
it We certify under the penalty of perjury.1,t the above . .foregoing Information is tune and correct and that the applicant Is a resident of trdhu a and
co
owner 1 n ... buyer of.•:. atoremen:fed property o, ate appfcaDori is Med.
` , sip to I• fv7 - ''
4.-,-- Dale(month.day.wear)
X /!
X d m a/ A (number saeel end T code)
D t-
Person authnrfsd by duty execi:ed Power of Aoariey or by IC 6-1.1-12-0.7 Data(month day:year)
Address of authortted person (number and asset row:state,and ZIP code) .