HomeMy WebLinkAboutMortgage_Bye"•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R11 / 6-09)
S � Presaibed by DepartmeM of l.�l GavemrtreM Firence
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INSTRUC7IONS:
To be lled in FOfm �� ��
persan w by mail wiN the CountyAUditw or Counry Recorder of the counry whe2 the property is located. ,(�'(�
Fi(mg Dates: 7J Real PropeRy: Must file dunng fhe yeer fo� which the deduclion is sought. � N Coun� MMilbf
2) Mo6de / ManulaCUied Homes iwt assessed as Real Property Must file during the hvelve (72) months
before Ma�ch 31 o(each year the deduction is sought. ❑ County Remrder
See reverse side for additional inshucfions arM qualilmations. �
App&anl(�rormnpaUbuyer;sae�anicb�wisonraversesile) GIBSON COUNTY AUDITOR
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G- -i9- �o�-vao. ��a- 67 c�
As�seE pmpMy as IN Mongage / Contract "vWehtetlnrss unpaid as of Mwtgage / Contract mdeMedness unpaid as of Is Ne app6rant Me sde
March t. Mamh 1, airrent v� eate ol apPfi ' U 0 kgal « "tame ovmnY.�
(' %. Yes ❑ No
tt m. what a his! Mr erar2 sliara of intr,rest? If avmed vnM someone other than spousa. ifWicate with whom
If name on recotd is dAlerent Ilian tha� of aPP��. �ipte OeWw Is property in QuesCOn: MnuaM Assessed
Real Pmperty Q ArmuaDy Pssessed .--
Name ot rtwrtgagea «
�
m halder W mortgage
state. aM ZIP code)
Addrass of assi,y�ee (number arN stree; my, slate. end ZIP mtle)
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any other I � "1 � �e
Yes ❑ No .� v9, a9 /, ��i �'�"' n?"-( [`°� �
Dra�t�er NO...�� /
wMOY. .............
� �— Card \'O. �?1�.�./............ I
Counry
;te0 m praperty
Yes ❑ No
�_
oatn (moruh, ear, r��
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I/ We certify under �he penalry of perjury Nat Me above aM foregoing intormatlon is We and mrtecY arW 1ha[ the appiicant is a resident o( Indiana aM
owner I cantracl buyer ot the aforemerrtioned property on date apP���tion is filed.
IMNre (owrah !u0 name) -� Date (rtmnth. daY• Y�+�
Pem,on autlw¢ed Ey dWy ezMV:etl Power
ce�
Oy IC 61.142-07
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