HomeMy WebLinkAboutMortgage_Tooley.+.�•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,, ..: FOR DEDUCTION FROM ASSESSED VALUATION �� 4 ��I
State Fwm 43709 (RB! 2-07)
���; •� Presaibed by Department of Local Govemment Finance '
INSTRUCTIONS: DEC pF�[UUiS
To be filed in person or by mad wdh the CountyAuditor o7 the county wheia the property is bcated. �
Fding Dates: 7) Real Property: Dunng the 12 monUrs be(ore June 11 0/ fhe year fhe deduc6on is to be etfec6ve.
2J Mobile Homes assessed under IC 64.1-7: Befween January 75 and March 2 0/ the year the deduc6on��0;b¢ efleet�
See 2verse side (w additional insWC6ons and quali(rafbns. �j � Q'
GiBSON COUNTY A I'
Applicppt (owner a mntr�! bvyer - see resirictims on reverse side) A__� „
vdue of real
ro.
—!Y'/ ' - —
t, aarenl y�r Mongage I Contrac
wnent year
share ofinterest?
�fame on recad is difterent Ihan 7hat of applican4 ��inte below:
Name of mortgagee orcont+acl sHler
Address of mortgagee or mnlraG seller (num6er eM streef. dty, sfate, ard ZIP code)
Name ot assignee or olher owner or holCer of morlga9e
Address of asvgnee (number a�M s4eet, ctity. state. and ZIP code)
Does applicanl o.m property in any olher If yes, whal counryl
counry in Indiana?
❑Yes � No
cour
Deduclion apprwed in the amount of:
�
SignaWre
2b _ I 20 _ I 20
.('00 %
as of March 1,
wmeone
Record nurm/be� Papge [n�umb?er
� 'G O 7 J �...
Is ihe appGpnt Ihe sde legal a equitade owneR
❑Yes ❑ No
spouse. indicale with whom.
Is the properry in queslion:
❑ Real Property ❑ Mobile Hane (IC 61.1
_ - - Q�°a �
_ ��1 �,��
,�, �`�"�33 �
uves ❑ No
AUDITOR
20_ � 20
Cay,
20
1/ We certify under the penalry of perjury ihat ihe above and foregoing information is true and correU and that the appiiwnts was I were a resident of
Indiana and owner of the afwementioned property on March 1. 20
Signawre (owneYS /ulJname) � Date (monlh, dey, yea�
Address
�i appicaM (number antl sUeet. cdy. state. and LP cnOe)
BseN sj 0,4H�-/FND ct
duy executed Paver of Attnmay a by IC 61.1-12-.07
peraon (numberandstreeLoty.state.aMZlPwtle)
.r
oau (monm. dar. r��