HomeMy WebLinkAboutMortgage_Ernst"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u p Year
:__ s FOR DEDUCTION FROM ASSESSED VALUATION
• . �• State Fwm 43709 (R71 / 6-09)
,,«. � Presai0etl Oy DePaRmeM of Lxal GovemmeM Fuance
wsrRUCnoNS:
APR 4 261� Man�
To 6e filed in rson w 6 mail wiN the Coun Auditor or Coun RecoNer of the coun where fhe rs 1 �� �
ae r b N N a�ae�N �e$.
Fiting Dates: i) Real P�operty Must file during the year for whicA fhe deduction is soughf. County Auditor
2) Mobile /Manulactured Homes rrot assessed as Real Property Musf fiie dunng the fwelve (72) months
6efore March 31 oleach year the deduclion rs so ht. �IBSON COUN Y ITRl6nnty Recorder
See reversa side for addi�ionel instiucGbns and qualificafions. �� ,��jy� � /./N /J/Xnct1Y)
MP�nI (nWnerqr conhaC 6uyer'see rest�lnns qi reverse sEe) '% '
d mortoaoeeh rontaa
MdRSS of nn�ag� ar
Name W assignee or othrs awner
near�s
r/ Idesuiption
�/1pr(p�g-/�-/U�f- oU 7
Marrh 1, airtv�,{yrar �n�npaid az of
G��
that of app9cant,
Iuxnt wm poperty in any o�her
Ind"ana? ❑ Yes
Deductian approvtd In ttre amount ot
smte.
No
stree4
zo _ , zo , Zo
a cow,a a,e��
GOUNTYAUDROR
zo
I I We certify under the penalty of perjury that the a6ove and foregoing intortnation
owner I wntracl buyer ot ihe aforementioned pmperty on date applicatlon is filed.
W
E Dy duy
state,
w by
Disbict?
bteCness un7aid az d I Is Ihe aVd�imnl fha sde
legal a eW ilade oHne(i
❑ Yes ❑ No
spouse, indi�ate wnh vAwm
7�GP+�Y in Question: Mm�aDY Assesud
eal Pfoperty � M1nuallyASSeued
Mas Na tle0u�'llon Deen rcVUesleO an 7�Y
fOt Wrt2nt y2d(!
❑ Yes ❑ No
avl 1 . �°—
Dra���er NO ..................
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