HomeMy WebLinkAboutMortgage_Brothers.' °•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T Year
� FOR DEDUCTION FROM ASSESSEO VALUATION
State Fortn 43709 (R812-07)
�' , 1 R�mbeC by DeparVnent of Laal Govemment Finance
i�M
wsrnucnoNS: MqYF�� �Aad�08
To be filed in person or by mad with the CourrtyAuditor o/ the county where tlre pioperty is located.
Fding Dates: 1 J Real Property: Dunng the 12 months befwe June 77 W the year the deduc6on is fo be eflective. ��y�n/ �
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 2 0/ the year the deduction is to Ife e�e.
Seereverseside/aaddiGOnalinstrvcGonsandqualifications. GIBSON COUNTY AUDITOR
(owner�mntracfbuyer- res4ic6 reversesee)
. ^,
'Y
sUiA (ey num6er / legal desaipUon
0-/3-19 -i�/-oo
ralue of real popaty as d Ma� 1. ctrrent y�r Mw�gage / Contract
cvrreM year Q �
I�whai is ha / her e:ad share of
If reme m recortl is dilferenl Ihan Ih
Nartre of mottgagee or contfacl selle
belrnv:
Address of moAgagee a mn�racl seller (number aM sfreef. dty, state, arM ZIP code)
Nama ur assigriee « atl�er awrrer or naa
Address of assgnee (number anO sheet.
DoeS appicaM axn Paperty in arry dher
couNy in Indiana?
❑ Yes ❑ No
DeduGion apprwed in the amount of:
20 � 2Q
morlgage
d!}; sfate, and ZfP code)
I( yes, what
� I �
Remrd numbef Page number
a/ -oo 00 �� � �--
edness unpaid as of March 1, �s Ue appficant Ihe sde legal ar equitade owneR
Q� ❑Yes ❑ No
I( owned wiih someone dher than spouse. indcate with whom. —
Is the WopeM1y in 9�tion:
� Real Property ❑ Mobile Home QC 61.1
Dj'a tiver �\r p ,,Z �.,� �' —
card i1ro. ...., °�' � oZ �'•..
20 � zo
�_
Date (month, day, yea�
, a�N
❑ No
�
I/ We certify under the penalry of perjury ihat the above and foregoing information is We and corted and tliat Uie appiiranfs was I were a resident of
Indiana and owner of tlie afwementioned property March 1, 20
�naWre /ownds MI nama) . Date (monfh. aaY• Y��
auihor¢ed by duly
Power
stryoL cdy. stale, and LP mda)
Address of authoraed perso� (numbei and sfreel cdy, state. aM Z!P wde)
6
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