HomeMy WebLinkAboutMortgage_Gonzales (2)^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ni vear
__ .+ FOR DEDUCTION FROM ASSESSED VALUATION
: . . • Stata Fwm 43709 (R71/6�09)
�' ,.,. � PresciDeE M DePart+nertl o( Loml Govemrtrer�l Finarrz
wsrRUCno,vs: JUN 3 OF��`
Fo d wRh:
To be (ied in person w by mail with Ihe CountyAUditor or Counry Reco�der o/ the oounry where the property is IocateA> �
Fd"mg Dates: 7) Real Property: Must fiM dunrn� the year for which Ihe deduction is sought. unty Auditor
2J Mobde / ManufaUUred Hortres rrot assessed as Real Property Must fiie dunng the twelve (12) months
6eforeMarch3lofeachyearthedeductionissoughG GIBSONCO NT U PPmRRecorder
See reverse side !or additbnal inshuctions arrd qualficatbns.
AppG�anl(owrerormJ(prl6uyeS-seeBStri'�b arreversevtle) _ )
d 2al P�Y as d
tt ro, what is his / Mr exac[ share of intelest?
If fwrie m remN is EiRerent Wan that o( appbcant iiMicate below
Nartre W rtnrtgagee ar
RewN number Page �wwmber
D / -000 � � Ga 7
'v�tlebtetlness unpaid a d Mortgage I ConVav uWebteCn�s unpaitl a d Is Me epp4ant Me sde
r date o( appfxatan tegal or eWRahle owrel.�
� Q ❑ Yes ❑ No
H awnetl wiC� someane ather tlun sPa�. indim[e wmh wMm
Is ihe P�PertY in qunstion: MnuaAy hssessed
(�Rga� RoPertY Q M^uaI1.1! Assessed . - -
se�er (numbri aM strect, ciry, state, antl LP cade)
a����e
Adtlress oi assgnee (number aM sbeeL dry. slate. and ZIP code)
Oces e�innt wm poperty in any oNer
counry m Indiana? � . _
amount aF
20 � 20
yC5.wh3ttount�? IWtal
COUNTY AUDf I UR
— i __
o?O �d.......
Dra���er NO....:...�....
cz�-�, (�,9�7 ' ,
��tia.�oo.?�s � � : ,_ .
20 20 _ 20
Caunry
Pi�]
�
�
❑ No
I I We certify unAer Ne penatty of perjury that the ahove aM frnegoing intwmatlon is We and correct and that Ne ap0licant is a resident of Indiana aM
owner / contracl buyer of ihe aforementbned property on date applicalion is fiied. _�
�� ( y// � /M .// _ . �.. Date (monN. day, Yea�
Penon authortrN Ey dWy ezecuted
AEtlren of authorrzed Verson
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