HomeMy WebLinkAboutMortgage_Lloyd—�., ,
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C u i Year
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• FOR DEDUCTION FROM ASSESSED VALUATION
.. Sta[e form 43709 (R71 / 6-09)
�S i P25vibed OY OePartrtren� of LoCel GovernmeM Fu�ance
srRUCnoNS: MAR 1 ���
Fo¢n fleO witl,:
To be filed in person w by mail with the CounryAuditor or Counry Recorde� o/ the county where the property is focatea .'�.
Frlirg Dates: 1) Real Pmperty: Must file dunig Ne year for whirh tha deduction is sought. unty Auditor
2) Mo6ile /ManulacNred Hortres rrot asseued as Real Property Must h7e dunng the fwelve (72) months
be(oreMarch3lo{eachyearthedeductionissougAt GIBSONCO NT U �fiReeorde�
See reverse side for addttional instructions and qualifications.
MP��t �owner orconfraG buyer- s� ricnora m rBVerse side) V L� .
C�
f xal PmPertY as d
Y�
his ! her e�a share of interest?
If fume on recoN's E'ifierent tlw�
Name af mort�agee or contract
r I legal desaiption Y RemN number
t�s -3s- aoo - oo/ -oo
�Ba9e / Cantract iMebtetlness unpaid as of Mongage I CanvacY'vitlebtedness unPaid as of
March 7, airtem year Cate o( eppticatian
lS�f Oc�O
tt owned wiM �meone oNU Ihan spouse. iMicate with wha
omer awner ar rwper rn rtqrtgage
(nuTce� em suee4
Does applifant own praperty in any oNer
counryinlndiar�a? � Yes
(
D�uction approved'ci the amount ot
'0% 20 _
V / %
Syram dCamNAUEiwr
C 1' Yl�-e�-
I/ We cerlify under Ne penalty of
ovmer L�ntracl buyer of thy� ator
Gy dtdy executed
20
�ry that thE
ntloned pn
l �� Gh:
�n�c
Attomey ar �.
Page num0er
v� u r+o
perty in Question: M�weAy AssesseE
ProPenY ❑Amu�YAss�sed
� _ _
ci(y, stafe. aM ZIP oode) L�� p' t. K�' �
�F�A�y �
-� -i�
;, what muntyl
a.70/� L
YfialTadig DisUiG7
IUNTYAUDROR
20 20
�
. �
rw artern yeaa
�_ � p_
�Y.Y��
and foregoing intortnaGon is W e and cortec[ arM ihat the applirant is a resident of Indiana aM
i date application is filed.
arnd
Pddress of a W�a'ned persan (numbereM sbeef. rily, state, arM LP code)
Date (rtronN, day.