HomeMy WebLinkAboutMortgage_Toll.r m STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�,., _ t FOR DEDUCTION FROM ASSESSED VALUATION
S�ale Fartn 43709 (R8 / 2-07)
�� �� Presmbed by DepaMient of Local Govemmenl Firiance
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INSTRUCTlONS:
To be filed in person w by mad with the CountyAuditor o/ the county where the property is bcated. � U � 1 � Z � � 8
Fding Dates: 7J Real PropeAy: Dunng the 72 months be/we June if o/ the year fhe deducGon is to be e�fective.
2) Mo6ile Homes assessed under IC 6-7.7-7: Behveen January 15 end March 2 0l tha year the deduction is to be eflective.
See reverse side /w additional insWctions arrd quali�cations. ��/.-c�
Applicant(ownercrmntr�Udryer-seere9�icfionsmieverseside) _, � ,� GIBSONCOU�ALJ�ITnR I
TeArg ct � Key number I legal tlesCflpipn'
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Assessed value of mal Popab as of March 7, arrerit y�r Mort9a9e I ConVaU
anent year
exaq shafe of inlele5l?
If rqme on recad is d'Aierenl than �hal of applicanl indiple belrnr.
�f�eeor seller
Address af mortgag�IraC seller (number aiM .��eel. aty. #afe. and ZIP cotle)
Name of assignea u dher owner or hdder n1 mM9a9e
Adtlress of assignea (number end sVeel. dty, state, and Z!P mde)
Does applican� o.m property in arry o�her
couNy in Indiana� �/�
❑Yes �v}vo
appmved in Ihe amaunl of:
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Irress unpaid as of Marrh 1, �s �he appfimnt Ihe sde Iegal a equitaMe owneYl
, �� �'es ❑ No
If owned with mmeone other Ihan spouse. indicate with whom. �
P��rtY in queslion:
al Piopertv ❑ MWzle Home
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whatcaunty? WhaiTerzin ra\\�Ct �O•
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couNrvauorrort . ` rC�� � ` , M `g L! (�, �
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I/ We certify under the penalry of perjury that the above and (oregoing infomiation is We and corred and that the appGpnts was I were a resident of
Indiana and ovmer of ihe atorementioned property on March 1, 20
�y� (owne/s fiAI me) �� Dafe (monlh, daY. Y��)
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sident address of applicant (number and sGe&. cdy. state. an0 LP wde)
S7u/ S GSD� �ccsca� SN
Person aulhoraed by duly executed Power of Attaney or by IC 61.1-12-.07
Address of ainhor¢ed person (num6er antl sheeC aty, stafe. and ZIP oode)
anlh, day, year)
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