HomeMy WebLinkAboutMortgage_Beasley""+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ _� FOR DEDUCTION FROM ASSESSED VALUATION
SFa[a Fortn 43709 (R71 / 6-09)
S / PresaiEed q' DeparlmeM W local GoremmeN Fuance
�«.
INSTRUCTIONS:
To 6e filed in person or by mail with Ihe County Auditor or Counry Remrder o7 Me county where the property is located.
Fitirg Dates: 1) Real P�operfy. Must hle durirg the year fw whirh fhe deduction is sought.
2) Mo6�le / ManufaUuied Fbmes rat assessed as Real Properfy Mus! file during the RveNe (72) months
6efore March 37 0! each ye»r Ne deduUion is soughf.
See reverse side /or additional insVUCtbns and qualficatrons.
I AoofeaMl9maror mitraC 6uw1 ve msfifd:ms on rBVa+se sidel
M^sessetl rahie d real P�*�Y az of
�1mrh 1. anent Year
n no, what ts his I her e�a share o
M nartre m remrd'a SRterent Nan tl
matgagee or contraG seller
of rtMOaace or contrad se0
Name ot assignea w other owner
� 1 VYUp[y.�d'rtor
❑ � Counry Remrder
GIBSON CC
ori / al E �� RxoN numDer
-/�- o-aov-000.a -oo ,o
hbrtpage / Cantraa ude6tednas ur�paid az d Mangaga I Con� inEebt� un7aN as d
March 1, arre�rt yrar Eate ot appOtation � / i
and streef, ctly, stete. ard LP oode)
naaress or assyriee (��rrmare�e sdeec ray, smre,
ooes eppinH oM, v�v�r � �y �,�
munry m Indiana? ❑ No
n Yes
appmred In 1tre amount of:
u yes. wnai coun�yr
�
`3
7� �� � U Yw LJ No
sPa�. uid�cate wRh �Mirnn
�h prapertyin7uestion:Mm�aPjASSesseO
Real PtoPeRY Q Armually Asse.SSed . . _
a010.........
r ...
llra���cr \ ......
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Card ��' �'1'��5a'�;#?..
�, �
❑ No
20 _ 20—qJ I 20 20 _ 20 _ 20 _ 2b _
��I��
�funue d Cumb AW itw � Counry Date (rtrmM. daY. )esfj
I I We certfy urWer Ne penalty of perjury that the above and foregoing information is true and correa and that Me applicant is a resident of IrM'�aria and
ovmer / contrad buyer ot the aforementioned property on date applinqon is filed.
�y� (oxrer's fiN�a1� /� � (� �Y. YeBA
'F�_, � . n J/ �On /�-(�t.�.L `/ / /�� ( O
. ..g _...._.. �_ _.
Pason aut�a'ved �y dWy
�n:
(numDer and street �+�Y. ��. � LP tode)