HomeMy WebLinkAboutMortgage_Bruce (4)'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:__ , FOR DEDUCTION FROM ASSESSED VALUATION
� � State Fortn 43709 (R77 I 609)
, y,. PRSaibetl bY �Pa��nl of Lool GwemmeN Finente
ile
INSTRfJCTIONS: Farm med with:
To 6e filed in person or by mail wiM the CountyAuditof or Counry RecoNer o� the counry where the property is located. A � Q� Q
Fitirg Dafes: 1) Real Property: Must fJe dunng the }rear for whirh the deduction is sought U� �ounry Auditor
2) Mobde / Manufachred Hortres rat assessed as Real Properly Must file durirg the hveNe (12J months
6efore Ma2A 31 of each yeer Ne deduction is soughL ❑ �� R��
See reverse side for additionaf instrucWns and quelificafions. �J'
"°a1°`"� °f�"�d°b"�`-58B `�'��8� ' GIBSON COUNTY AUDI
°b
�T�nvflicein _ ev munbef l Imal Eeurio' Remrtl nwoher PaGe nurypr; �
-� ����"bZ%� `j-�
/ Contrau IMebteOness unpaid as of Mwtgage / Can:raa iMe6ted�ress
vrtem ymr date of appGtatian
of infrJest?
H name m remN a 6ftemnt than ihat d aGP��t hNkate Cebw:
a�
se9er
�,: ��.
w a� o�� a nwae� ���ya
aM street �Y. stale. end ZIP code)
Dces ePpli�nt own propeM1y in any oNer
aunry m IrNiana? I"I .,_'
u-srt:�-t
20 _ � 20
Sig�GUe N
No
rc owned vriM mmearre aher Man spouse.
PIOQPlIY Ifl CUPSiCII: Mf1U2M �SGO
/ �I ProPertY Q Armualiy Asessed
? ! � Mobile Hame (IC 61.
,�„� {3 f:,UC� i'�UO�J
mlc.i� �
- ,(j� cEi Qoo ���, �
/' i ��� � �
/ J�. Ih �%� �S sted m prope.M1y
/" � `' � � ❑
- #�.jU, Gi�o_ '1 �—
i
_c /o
20 _ � 20 _
Counry
20 _ 20 _ 20
I/ We certify urWer Ne penatty of perjury that Ne above and foregdng intormatirn is We and corteU arM Nal fhe applicant is a resident o( IMiana arW
owner! mntraa buyer M the aforemerrooned property on date appl'cation is filed.
7fanue N0 narre) n Date (rtmN. daY. Y�� �
�:
PersOn autlqi'¢ed Cy dulY executed Power of AllomaY «EY I
Pddr� d autho�etl 7P+"� (nnmGerard.wee4 �4Y• sfa[e.
��� �oj`� _ -
Date (rrrontA. OaY Y��