HomeMy WebLinkAboutMortgage_Buck (5)n STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
S_N r; FOR DEDUCTION FROM ASSESSED VALUpCillQtd� � T
State Form 43709 (R71 / 6-09) �i 1 1J
,� Presrnbetl by DeparlmeM ot Loral Gavemment Firence
File Mark
INSTRUCTiONS: (� (; ,(�
To 6e filed in AU iy Y� 4F��� F� m� �:
personorbymailwiththeCountyAuditororCounryRecordero/Ihecoun here pertyislocated.
Fifing Dates: i) Real PmpeRy: Musf file duri� Me year for which the deducGon issougl�,t.,�,_ � Counry Auditnr
2) MobBe / Manufecluied Homes rrof assessed as Real Property Must frle dOhHg,its-hveNe (12) months
6efore Ma�ch 31 of eacA year the deduction is sought v �\ ❑ Counry Recorder
SeereversesideloraddilionalinstmctionsarMqualifications. GIBSONCOUNTYqUDITOR
Key rv�mn« � kgai desaivtim
,�/ , a0-� I- �ftb -cn0. t� �' -00 �
�55eG ralue d rnal property at of ge / Gont
art3i 1, aamntYm Me 1. a��i
�Pl
110. N'hdf 6 h15 / i12f EYN15h2IE 011I1�Cf251?
riartie an �ecad 6 QdFerall U�dn Nai O( aPP�^L mtluate b2bw
oonvactse4er
Pdd2u W rtnrtgagee or m
o�-;�„���� `o
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C:1T(�.��• .
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0
Veauction apryoveC m ihe
20
.�Qi,.a.....
3'�$9.......
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20 I 20
numbrl
Is Ihe applimnt �he sole
legal a epuitahle owneR
❑ Yes ❑ No
If awneC wiN someore oiher tlian spouse. indicate wBh wtwm
!y. sfate. aM LIY cotle)
e,
_ at counl7R What Ta�dng Oistricl't
COUNTYAUDROR
_ 20 20 _
I5 tl�e property in 0�: �nua0y Assesse0
❑Rea�aoaertv ❑lvmua�yAssessea
;rea o� v�r
Yes ❑ No
20 _ � 20
0
I/ We certify urWer ihe penalry of derjury that ihe� and (oregoing infortnation is We and cortect arW that the appiinnt is a resident of Irnliana aM
owner I contracl buyer of Ne afwementioneC pro on date applintion is filed.
Sigra�ire (owner3 hd rame) [� . I, tr�dtey (rnonRi. daY. Y��
�_,n o Q_Q.Qi�' \—�—CN2-� �3 — % — � Zi
FWI reti�tle}nl addR�SS] o( appfinnt (numberantl �st7reef, dty, slate, aiN Z�p e)
U 75 S J � � � / �
Pumn autlmrrzeE Ey tluty exeated Power of HttomeY a M IC F7.1-12-0.� Date (�^N. �Y• lea�
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