HomeMy WebLinkAboutMortgage_Folsom 'tea.,.: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year
�' 4: FOR D V, ! )e N SESSED VALUATION ENTERED FOR MA
- , J: state Form; .' .,•! s-og) for transfer
?Ito coal
p ' - m Finance a of
File Mark
INSTRUCTIONS: Q
To be filed in person or by mail with tfietouOn'tyAuditor or County Recorder of - ,: .,.party is IdtglibOr F0f`t'N�
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Filing Dates: 1) Real Prope .Must file during the year for which the deduc •r. .• ab`n•1.. Gibson County ZI.....-6e0RrAUditor
2)Mobile/Mar}.-ctured4 o - •- essed as Real Property ust file •uring the twelve(12)months
before Ma ..•f(•.n •,a:7 117(Li the deduction is sought. I ❑ County Recorder
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Pare ��
See reverse side foT.:. g,.lqgriacilY a{1dllg} ons. -
MIr�n1(owneror..,/ : ■ • _ i • • • • or • • -
Taxdn • Key number• chaser-7p) tion Record number Page nu
f �i -ad ooa. 7 8 3-oa 6 (frL 99
Assessed value of real property as of Mortgage/Lact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,anent year March),current year date of application legal or equitable owner?
YOOX , . I ❑ Yes ❑ No
If no,what Is his/her exact share of interest? / If owned with someone other than spouse,'\icote with whom
If name on record a(afferent than that of appbwnt,indicate below. I 'sensed
• aoi3 L4Iq9 iesSad
'e(IC 6-1.1-n
Name of mortgagee or contract seller
alt-A--Iat-AI I
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) I ( �O
Name of assignee or other owner or holder of mortgage I U •
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? -
I Property
county in Indiana? ❑ Yes ❑ No I IIII No
I I _
COUNT\
Deduction approved N the amount of:
111 I I
20 20 20 20 I 20
/ I
Signattte(f. • di County Date(month,day,year)—
11 We certify under the penalty of perjury that the above and foregoing information is true and correct and that the app cant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
nature(owner's hi name) --- Date(north,day,year)
a.s ll,.. I
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tyq reside address of applicant(number and street,sty,state,and ZIP code) p
r q D a .� nil a.(n•1 .r te -4,4 .,MXn „Ji vvt to Lag 8'
Person authorized by duly executed Power of Attorney or by IC 1.1-12-0.7 D ite(month,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code) I
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