HomeMy WebLinkAboutMortgage_LLC (8) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
County_ i Township I Year -1
1:4,1,-- itt FOR DEDUCTION FROM ASSESSED VALUATION _
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Gibson I 0 i
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Prescribed by Department of Local Government Finance l 4„)Da File Mark _
b,,,IS TR UCTIONS To be fled in person or by mail
Form fed v!..-I.th - —----.
ceiling D.-7.',7: Form must be completed arid dated in the calenda-year for which the deduction is sought
I r!L,_..3 ty t
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Coun Audi or
located on Of before January-5 of the ca:endar yea-in chic'-I the p-opedy taxes are first due and payable i__
1 '
1 __! County Recordo-
see reverse s,de,for addttionat instructions and qualifications
Ap;,-,'.;',,,a-v.(c...r,E.--o-co,:ra.:',!b... es.:,,...-,-see r-s!,:'..f'7r1S.Cr re.-,-‘..........-LsL
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.T.r.s.art:Or-st:0 st- 1 Ke c...1e., ;I -a es!s-otter Zaccre,nembe- I P! acre ranclzr
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,..„.„,,,,,,v,:ue:s'r,.., pro,tert„, ss.c." !f.'crtt-tage,1 Co ineet-,sehess uspa e as ce! 1 t.lc-t-gagtea i Ccntraet meatteeesronc,,,!,,..„,oF i Is tr,;:,,,;car,,1.,,;; ;:-..---
a5SeSS--art eate cs-rant Cu'y assessment date current yea- :data c`app0cat!on
1: > legs!'or equitates 0,,h.s-7
___!___14_ .-1Q,.., 060. ------ 1 1.„...------Yes E
'No
-1177-c-ii, ;.a.li-is hi--,711enJSC-17sT-,;--c:, ir,tE-..-51, ,I ca .....,,.. .someone othe-Iran spouse Indcate v..-th',hero
—- I I ..........ds tne pr-pees, ir-quest'en AnnsaIty ii-Tsse....s.see
If Ma---eOniracri.ri-Td`TereTrittrier vie!c`sop'cant i7d:,a!e beso...
14,,jirlleat Property D Annually Assessed' Mobile Horne(IC 6-1.1-7)i
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,--i„,-,-"-_,-„,":o''r--,0-4.:a.,,-3-2.0' cntsant sa'!/-/-(hurnCer a-7,1 s!-E.• :!,/ .,,-; !s..-a,d.Zit,'c,d-:--,
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rsi a-1>u c'aas!gnee.o-°the-ov..nar or
-ic,--a-7-,----,-,:•:_ --c--ff aii,si,nocie(rue-for arc's Drawer NO...a'70alv 2- '---------------- -- -- -G..
pc:Tae.a;_‘7.--‘'neant c...--p-occe,/is ar! , 3 39 -Jeet-../ !on r..-G-4.4400v - lit:10.Warnocut of eeduct!on !
othe-county , , Card NO. !/ty for •
in Inc a-a9 L Ores E le i‹-D.
A person is not entitled to this d, Ige or co t of indebtedness that is re-66AdiRf in the county
recorder's office(including any home equity tine GI cred:ma:Is recorded in tee county recorder's office)t at 's the basis for the deduction
COUNTY AUDITOR
D.,..---i-L.ict.on acp-evect m the arn-eli!eft-...f
20 i 20
1 20 20 20 20 i
20
1 i
Snn,' r.i.-,of Counly Auditor !Citnty 1 Date(,,,,r7:17 day yad-)
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i i , certify under the. nasty of perjury that the above d fliving information is true and correct and that the applicant is a resident of Ind.ana and
tr -t b yer the aforementioned property on date - l cation is filed :
fu arne i Date(n-entn da;}read
' I *.ftiA' 'c _00.:
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-r;st set ety staIe one Zi cces-; +::f.j......A_".--------------- ----
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Pa-sen hor:Ziatt b do,r !si execute:: o F,sc...e- f Attorne,cr bi I 1 2-C C -1 7 i Date(nrcret day ,..a-,— •
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aiutircnzet per5oh (r;o r,t..re r and sped t cej stale and ZIP code
The oeoa!tes for perjury can include imprisonment up to tab and a haft'yea-s and a fine not to exceed.510.000