HomeMy WebLinkAboutMortgage_Fuhs (3).•�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS • n, T shi Year
�, __ � FOR DEDUCTION FROM ASSESSED VALUATION p;
State Fartn 43709 (R8 / 2-07) g. J ty
�0�; � Presaibed by Depanment of Local Govemment Finance
V=� 3Fileil�erR
INSTRUCTIONS:
To be �led in person or by mail wRh the CountyAuditor o/the county where fhe propeRy is located. �
Filing Dates: 7J Real Property: During the 72 months befae June 11 0/ fhe year the deductlon is to be eRective. n,�
2J Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 2 o/the year the deduc6on is fo � aNecNve ^
See reverse side /or addi&onal insWctrons and qua/ifications. GIBSON CpUNTy ✓
AUDI7pP
� /1
contrdq
on reverse srtle)
TaA Dis�nct '" Key n�Ahber I legal des�Ltion Remrd �., '-
a.�.�-►� _ - /8 - /DO - o o /. 9Y o - o o / �jp •
Assessed ralue of mal poperty as of March 7, aarenl yeer Mwtgage / Contrad indebledness unpaid as M March 1, Is Ihe appGmnt Ihe sole
wrtent year � � � D O (�
If ro, what is his I her exacl share of iriteresl?
�me m recwd is d'rfferent �han �hal of applicant, indipte below:
Name of rtwngagee or canVact seller
_�'G
Address of mortgagce or conUad seller (number aM sfreeG ory, 4ate, ai
Name of assignee w ather oaner w hdder of mortgage
Address of assigriee (number eiM sGeet, city, sfate, aM ZIP cotle)
Dces applicanl o.m propehy in eny dher If yes, wlial coun
counry in Indiana?
❑Yes ❑ No
Deductian app�oved in the amount of:
f�Z�7
Sigroture of County Audilnr
20 I _�'/ I 20
I/ We cer6fy under the penalty of perjury that the above and foreg
tndiana and owner of the aforementloned property on March t, 20
e
spouu, indicate wi� mm.
Paqe number
� d77 �
�i. �uaeowrren
❑ Yen �'
Islhe propertyir eslion:
❑ R�1 Propr , � Mobile Home QC 61.
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Dra���er NOGt��. .05%7�
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address of�dpplic5nl (num6ei entl sheet. cify. stafe. aM ZIP cude)
F SR. /68 Frt.Bro.��ti r.� 'f76Yb'
mzed bv dulv eze[vled Power of Altomev o� bv IC 61.1-12-.07
Address M aulhoraed penm (num6er eM sfreet, aty. sfafe, eM
20
was f were a resident of
daY Y��
Oate (monfh, daY Yee�