HomeMy WebLinkAboutMortgage_Rottet^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__„ a FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fortn 43709 (R71 / 6-09)
�` PRSVibeC GY DePaNra�� o( Loral GovemmeM Futance
�STRUCTIONS:
. To be filed in person or by mail with fhe Couny Audito� or County Recorder of the counry where the property is Io�tRq. �
Fil"mg Dates: 1J Real Property: Must file during the year for which the deduction is soughl. IVIAT
2) Mobile / Manufactuied Homes nof assessed as Real Property Must file dunng the fweNe (72) months
6efora Malch 37 0( each year the deduction is sought C.'J. IY�
See 2verse side (or additional instrucLOns arM qualifiwtions.
Counry Auditor
County Remrder
App/Gr�/nl (owne�or/cJontrect6�vy/er-see�ewirl,unsmre side) GIBSON COUNTY AUDITOR �
.( l/n ..�liOX/ � Y' L��1�C/
Pssessed vahm U real V W�
�,,.��
I( ro. whal's his / hu e�tl
�( f WIIC Of1 f0C0fd 6 QfR0R1
Key rnim / kgal desaiption RecoN numbrl Page numbr!
� ��-��f—I�-Yo _ool•3zy-o�7 �. 2io3
y Mor�age / Contraa iMe6tetlness unpaid as of Mortgage / ContraU hWebtetlness unpaU as d Is Ne eppfxant ihe sole
MefCh 1, artent year dale of apptitation legal or equila6le wmel!
39ood ❑��❑No
hare W interest? H a�metl witn wmeone oNer Ihan sPW�. indirate wM wMrn
Nan ihat o/ aPP��. ��� ce�°^' `is trhe property in Quesfion: MruaDY tissesud
'u Real Properly Q lvtnuallyPssessed . . .
o} �yayy¢a a �ntract u0er A. �
/'�i
Mdress of matga9ce or mntrac�
Name of assignee or oNer wmer
Ad�ress of a,ssynee (number an suee4 �y, smie.
n�t'-e,P.�.�.� �e
linnt ovm property in any oNer
Indiana? ❑ No
❑ Yes
eM street �Y• state.
o�naae�ornwnyase
Oeduction apWOVeE h�
of.
tle) �
�a� m���
Rc%f ft T ��` 3
M ""f `iA7✓c
�a _d io3
No
20_ I 20 I 2Q I 20- I ZD- I 2(1- I p-
Sigfunne W CounryAUditor Counry Da�e (monN, OaY.S'za�
I I We certify under Ne penalry peryury Ihat bove and toregoing infortnalion is W e and correct arW that the applirant is a resident of Indiara aM
owner I mntracl buyer of the afwemeMioned perty on date application is filed.
� re (owne e
Date (monfi, daY. Y��)
F resideni of appG� t(number antl sLcet, tlry, re, artl ZIP e)
/o u
Pe�son aufhoRed �y Ouly executetl Power o( Anomey m by IC 61.1-12 .7 �ate (monlh, Eay, yea�
P4dre55 of aWwr'¢Etl persa� (number a�M sbee4 �: sYdfe, an0 ZIP mtle) .