HomeMy WebLinkAboutMortgage_Powell"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�__ , FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (R71 / 6-09)
�' w. � Prewibetl M �ePartmerd o1 Laol Gorammard Franca '
F' e
INSTRUCTIONS:
Form t�ed wkh:
To 6e filed in person or by mail witA fhe CountyAUditor or Counry Recnrder of the counry where [he property is located. p ,(�'n
Fding Dates: i) Real Pioperty: Must file dunrg fhe yrear lor which the deductlon is soughL � E J❑ �y�J�yty quditor
2) Mo6de / Manufactumd Homes not assessed as Real Property Must file dunng the hveNe (12J months
6efae March 37 0/ each year the deduction is sought ❑ County Recordu
/
See reversa siAe lor addilional inshucfions and qua/�cations. ��^'
Ap iwconna�buyer-see mrerersesiee)n GIBSON COUNTY AUDITOR
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u.`�T�
tt rwre m remE is C"tlfe2nt Nan tlut oi aDD�m. iMimte bebw
Name of mat[�a9ee or mntract sWer
Addtes oi rtart9a9ce or cantract
i:�7
oxner w
lirvrrt o.m proprny in any �
Indiana? ❑ Yes
�11 �Y.
�1�7
/
s/M�ZIP cotle) (
/•� G ��
u yes. wnat munryt
N�
I 20
Recortl numCrl Page numbx
r—00%l3 -007 b�0 81
: unpaid as of Mortgage I CantrarY indebtedness unpaid as d Is the applrcsnt the mle
tlate ot aOP�� legal w equila6le ovmeR
❑ Yes ❑ No
If awned with someo� other ttian spouse. iM'ra[e wiTh wlwm
COUNTYAUDROR
20 _ � 20
Caunry
property in Questim: MnuaOy hssessed
eal RoPenY ❑ !��!�M �
D�"a�yer NO..���� ....
CaY(� (�r�. ......,( VVl r
'� �9, 5�. �........ . No
20
Date (rrw.wh.
2(1
I/ We certify u�er Ne nalry o( perjury that Ne a e and foregeing intormalion is We and correct arid tliat Ne applicant is a resident of I�iana aM
owner / mntraa buye of the afaementiwied p on date application is filed.
�(o�mefslu9name Date (nn�Yh, daY. W�
�o _ � ��
�ent (numberand sLee; tity, state, and ZIP mtle)
yii � � ��- -- - -� �a�,�4 �. sr�G� —
yson autlwraed Dy dWy ex Power of Amrney w by IC 67.7-12 Date (monN. dfi: Y��
of autho�'ved person (numberaM snee4 �ry, s+afe.
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