HomeMy WebLinkAboutMortgage_Dawson� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ou 70� s ip Year
- FOR DEDUCTION FROM ASSESSED VALUATION
� • State Fwm 43709 (R71 / 6-09)
,,.,. � Preuri6ed by DepaNnenl af Local Goremmenl Fu�ance
INSTRUCTIONS: AUG �e��I(S09
Form fJed v.iui:
To 6e filed in person w by mail vnN the COUntyAuditor or Counry Recorder o/ the counry whe2 Nte property is located.
FiNrg Dates: 7) Real Pmperty: Musf file during the year lor which the deduction is soughL �unty Auditor
2) Mobde /Manulactuled Homes rrot assessed as Real Property: Must file dunng the twelve (12) months a" T
before AAarch 37 of each year the deduction is sought. �"ty R��
GIBSON TV AUDITOR
See reversa side lor adddronal instrucGuns end qualificafions. ... _
MP�9�(mmeroroonhaCduyer'seere.wictonsm�rersesCe) . /1 �
1 mal p'apaty as
�
iw.
Key numEer / le9al desmVlion Remrtl numb�
�6-ia- �-yoo-ao/.5a3-oo�f o09
MorVage / Contract udebtedness unpaitl as of Mongage / Contraa'vWebtedness unpaiE as d Is fie
Mamh 1, a�rtent Cate of aPP�� �eBa�
I � Or� D
1f narne on 2m�d'q Eitterent Nan Nat of appBrant, Ndi`ate Cebw.
Name of rtnrtgagee or mnirap se9er
�1��.,�Cir-� .S �
Addiess o1 matyagce ot contraG sWer (numbar and stry . riy. sbte, erW LP code)
�ror°, antl LP cade)
Ooes epditant ovm p(operty in eny oNer I If yes, what
munry in Indaw? ❑ Yes
❑ No
ction approveE in Ne amoun
2� 20
iwm � bNdimr
If awnad with somcone dher tltan spaise.
COUNTYAUDROR
20 _ 20 _
County
�5 7
ves u No
�s me wovero � v��: a,rwanr wss�ssea
❑ Real Propefty ❑ ArmualyASSeSSed
MoWle Hortie (IC 61.
Dra���er \O.. °��..1.......
c���a �o. ....�.T.1.57.........
� 13�,��.o�
2p _ 20 _ 20 _
I I We certity urWer ih penatty of perjury that ih�above and (oregoing infomiation is we and cortea and Nat Ne appluant is a resident of IrWiana arul
owner / mntract bu r of Ne afaeme�rtioned property on date appiication is filed.
�nawre (owne/s lutl ror�p) �(+�'+�, daY. Yaa+)
Futl resident address ol appi'rant (numDer anE sbeeC dly, stafe, an0 ZIP ootle)
�/3 9 ) S' ._rl'o r ��e.i.,,cc � ��-
Person auttrorrzed Cy duty exewted Power ol Actorney or Cy IC 61.1-12�.7
Pdtlress of auCmrtretl persan (numberaM sbeet �: sbfe,
r.v v)G��o
�� c�. �r. r�a�