HomeMy WebLinkAboutMortgage_Boop-"•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun'
: FOR DEDUCTION FROM ASSESSED VALUATION
• S1ate Fortn 43709 (R71 / 6O9)
S I Prestnbetl M OeP�rd of Lod GovemmerLL France
INSTRUCT70NS:
To 6e filed in person w by mail wiN Ihe CountyAuditor or Counry Recnrder of the county where the pioperty is located.
Filing Dates: 1) Real PropeRy: Musf file dunr�g the year /or which the deducfion is sought.
2) Mo6ile / Manufactured Homes rwt assessed as Real Pruperty: Must file dunng the RveNe (12) monfhs
before March 31 of each year the deduction is sought.
See reverse side tor adUr(ional ir�sf¢ctions arM qualr�icalions.
�Mv��t(ownermmmafl R�°A� s� ^ �. �
If ro. whal IS hl5 J t� P.uG ShaR Of intrlest?
If name m remN a dMeran Nan Ihat of appOCant, mdicate Delaw.
_�-E c�„�ry�"�9
GiBSON COUNTY
�� /O(/ VO/. / � rteymm�umoe{�y reye�mnyw�/
to V/ `�
61edn�s unpaid as ot Mongage / Contra�Y inCebtedness unpaid as ol Is Vie appGrant the mle
+O ^ tlate of appGfation legal a equitade aw1wY1
U U ❑ Yes ❑ No
If owrie0 with someone other Nan spouse. ind'zate with whom
Is the praperty in Vuestim: Mm�aM Aswssed
❑ Real ProPe�Y ❑ !!^^!!�'J � . . _
Name oi mongagea w mntract seller e`l �w '�
Address d rtnrtgagee or cmtraG seLer (ru+nber and sheeL tdy. s7ate. aM 21P �
Name of essi�ee w othel awne•�: •. — —
ooes eppinnt w
couny in Indiana?
DeducCm approvad
20
� /we cervlv under
resident adtlmss W
i
;on auCprrzeE Cy dWy ezewced Power of Attaney w Dy IC 61.1-12-0.7
persan (numberarW snee; fiy. slate, aM LP ootle�
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p,��,���� �o.........��.
�i d ��• ... ��•�•�,.......
C 1�1,1��'vv a
20
na�ry of peryury that
the aforementioned
i
anl (number anC s 4 �
duraon Eeen re9ueste0 m P��Y
�r ❑ Yes ❑ No
20 20 20 20 20
Caunry Datc (nnrW�, daX yeaA� Q_Y1(
� c: i �� CJ
bove and (oregoing infortnalion is trve and cortect arM that the applinnt is a resident of Indiana arM
ro erty on date application is filed.
Date (monfh, daY. Y��
sfate,
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