HomeMy WebLinkAboutMortgage_Wilson"^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:. —
; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 43709 (R71 / 609)
�' � Preunbed by Depart�rleM of Loral Govemment Fnance
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INSTRUCTIONS:
Fortn N with:
To be filed in person or by mail wifh the CountyAuditw or Counry Recoider o/ fhe county where the pmperty is locat
Fil"mg Dates: i) Real Pmperty: Must file dunng the year /or which the tleduction is sought. � N 2 2 Counry Auditor
2) Mo6ile / Manulactuied Homes not assessed as Real Property: Must file dunng the nvelve (12) months
before March 31 ot each year the deduction is sought. C� Caunry Recorder
See reverse side for additional insVuctions and qual�cafions.
App� nt(oivner contract uyer-seerestrirti��� grnreverseside). (�� l GIBSON COUN
�/Yl i� �n„ � ,P a ( 'm� m � a 7 �i /. �nr.,,.. �
AssPSSed value of real popr.r.y as ot
�IarU t aaren[yrar
If rw, whal a his / her eract share af intuest'�
—� - ,��, �,��.
e/ Conbaa indebteGness unpaid as ot
artentyear
70 �i%J.c�
1I rwr�e m remN is EMeren[ than ihat of appGnn4 �ditate 6ebw
Name o( rtnrtgagee n
w mntrap seuer (num�Hi aritl sveet �4Y, sfate,
oi assi9nee w ov�er owner or noiaer at mortgage
ACCress of assignee (numbei aM sheeC riry, sfate. aM ZIP cade)
apptimrtl own poperty in any oNer I If yes.
v in IMana? .--. r,
�_�i �1 � p � �
appGCalion
Record number Pape numCrl
� aoo� �69�
ie tetlness unpaiC as M Is Ne appfcsnt Me sok
kgal a equitade o�vrwlt
❑ Yes ❑ No
If owrred wiN someone otMr than spouse.'udirate with whom
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NrtatTa�dr
COUNTYAUDROR
20
Caunry
property in a�estion: aimwry wssessea
�al P��ertY ❑ Armual�Y Psse��
D�a��e`.!`'O � . �—
c.,,.� yo � � �..�� —
��_ ��o �1/..(��9��7.. �. �P�
� V �.c..� • /� ❑
. r � � �
20 � 20 _
Date (rtiontl�, daY, Y��)
�
I I We certity u�ef ihe penalry of perjury that Ne above and foregoing informalion is true and cortec[ and ihat the applinn[ is a resident of InAiana aM
owner I contract buyer of Uie aforementioned property on date appliqtlon is filed.
and
autMraed Oy dWy ezea�tetl Power o( Avaney w by
of auNaaetl person (number a�d sveet ci1y. sbfe.
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