HomeMy WebLinkAboutMortgage_Miley (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fartn 43709 (R71 / 6-09)
�,,,� � ResaiEed EY DePerbneM of Loral GovemmeN Fu�ance
File Mark
INSTRUCiIONS:
To be filed in person w by mail with Ihe CountyAUditw w Counry Recwder o� the counry where the property is Iocated.AP R Ia . .
Filing Dates: 1) Real Pmperty: Must hie durrzig the yrear hu which the detluction is soughL � County Audimr
2) Mo6Be / Manufechred Homes not assessed as Real Pmperty: Must file dunng the tweNe (72J monNS���
6efora March 37 0/ eacA yEar the deduction is mught. !/'� nly Recorder
See�everseside7oraddRionalinswctionsandqualifications. GIBSON COUNTY AUDITOR
Mali7Gt (owner a contr'ac16N'er- see iestriuions m reverse vde) _ \�_ '�
i 'ct �/ rwmber / legal �sai7tian
�"d!o - oto-Od - �
ai vahm drnal qoperty as d Ala(qage/ Contraa iMe6teEness
t. amru Y� Mer� 1. wnent year
what ts ha / hrl eraU share of intrlest? '
ie m 2coN b tlilfumt Nan that of app0ont Ndibte Ec�o'�'.
� of rtartgagea or mntrati u0er i/
P� ���'�_s�
m a rtart9a9« or mntrae se0er (nunDa ard rd�; smfe.
i W assignee w atlier owner or holder of martgage
�ss ot assynea F{n�um0er eM sneeL �y. sinefe, end ZIP cade)
/i /' ` �
ePpimm o.m pmperty in any oNtt If y�v, wfial m
Y �� ����
❑ Yes ❑ No
aan approved 4i tlx amount of.
20 � 20 _ � 24
d as d Mongage I Cantraa ifWebledness unpai0 as d Is Ne applimnt tlre sde
tlate ot appGcation legal a ewitade owne!!
❑ Yes ❑ No
If avrt�ad xitli sort�one other V�an sDWx. udf[a2a vNA wfiom
8 . �r 9 �+ c�
> NTat Tadfg Dis
20 I 20
�Is th�e{y_o,�y m question: Mnually AssesseE
iX'.�°' P�e�tY Q lvmualyAssessed
�
D�-�„���� .o.....a°!:� .....
C.u'd \'O. .......� �.��.....
��� I�����
20 _
Date (monM, daY. l'��
20 _
I/ We cerVfy under jlfe penatty of perjury t the above a�W foregoing infortnaGOn is We and cortecl and that Ne appli�ant is a resident ot IMiana and
owner / mntraa buyer ot the aforeme ' ed property on date application is filed.
7na0ue (o hID name) Date (mon1A, daY. Y��
�irrun � �f —S' /O
ill��eddiess of rant (numDe�'an/d stree4 �Y. �te. erM LP mde) `%
ssona/utMi¢etlMdWye: �POweraf�Y«OyIC61.7-12-0.7 � If�/1 � I /'T,���OQaYY��)
Pddress of aWrarseO p�'..on (numberarE.wee4 ary, sb(e.