HomeMy WebLinkAboutMortgage_Mason (3)"^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ou' o s Year
= FOR DEDUCTION FROM ASSESSED VALUATION , /
� ' S�te Fwm 43709 (R17 / 6-09) _� v
S,,,, Presaibed by DeP��ril o( Laal GovemmeM Finance
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Fortn Ned wtth:
To be filed in person or 6y mati with the CountyAuditor o� Counry Recorder o/ Ne oo�nry where the property is located.
Fr7irig Dates: 1) Real Property: Must fife dunng the year (or which fhe deduction is sought. �7% County Auditor
2) Mobde / Manufactured Homes nof assessed es Real Property: Must file dunng the hvelve (12) mont� C�
6efore March 31 ofeadr yearthe deduction rs sought GIBSON COUNT A TOH nry Recorder
See reverse side tor�dd�ioaaLinstructions arM que/A'icatlons.
' aw ��/� I CesaiGOm Remrd numbar Page numCrl
. � -a�G 8� - � 3 9 `
As.xsed rahx d rnal poperty as ot Alortpape / Contraa 4deMeaness unP� a d Mar18age / CantraU "v�Aebtetlness imG� as d b Cie aOP�� tlre sde
M1tamh 1. wmv Year Mard� i. artent YPar Eate o� ePP�� � a W�ttade awneR
❑ Yes ❑ No
tt ra. whffi is his I her aua share af inteRSi1 tt ovmed with mmeorre ather Man spovse. tr�iCate with whom
tt fwr�e m remtl a C'irterent Nan mat ol aPP��t uMUaoe bebw —" _ ls tlm poperty in�uesGOn: MnuaoY Assessed
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wme ot rtnr�agee a mno-aci se�e�
O�o»� Drawer Np, a�/ �,,,....
naaress w mortgayee or m,o-aa n•,^ •^•°- -_, _•.....f, c j; sbre. ew z�P coae)
Name o( assignee or oNU owner w holtler ot mortgage
�a�o,�,�,�,e,��� �. ��, a,�
Does ePW�.�rt own D�P�Y in anr otlra
muniy in Ind�ana?
❑ Yes ❑ No
DCO�W0113�QIOV¢d Yl N8 a1M)IIl Of:
2o zo _
sg�an,�e a camry aba«
If yes, what muntyl
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Card NO. ..�./.y.(
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�UNTYAUDROR
20 20 20 2(1
(�m. aar. r��
I I We certify under the penatty of perjury that Ne above and foregoing informaUOn is We and cortect arM that the applinnt is a resident of Irdiana aM
o.mer I mntract buyer aF the aforementioned property on date appliptlon is filed.
in�ve foxtrefs fiN nertreh _ � , 1 Date (rrmA, daY. Y�A
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MEress of aW�a'¢e� Darsa+ (number aM sCeeG �Y. sta+e. aM
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