HomeMy WebLinkAboutMortgage_Fish"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o T ip vear
__ s FOR DEDUCTION FROM ASSESSED VALUATION �
. • State Fortn 43709 (R17 / 6-09)
�,u. ` P�eunbe0 Ey Deparbnenl of Laal GovemmeN Fuam.e
wsraucnoNS:
SEP �'�e�`^��9
To be filed in person w by mail with the CountyAuditor or Counry Recorder ol the counry where the poperty is located. F� �� �'
F�7ing Dates: 7) Real Property: Must fde dun Ne ear lor which the deduction is so ht. �
�9 Y �^J �4 �GWnryAUditur
2) Mo6de / Manulactured Homes rwt assessed as Real Property Must file dunng [he fweNe (72) rrwnths �//
6efore Maich 37 of each year the deduction is snught GIBSON OU�. , Y Cqu��g�aer
See reverse side for a�ditional inshuctions and qualificatrons.
IAppfxanl(ownerw uyer-see reYeffs siie), ,
:� __._ 01� -13
Assessed vWue oF2al �aoperry az d
Me�rh 1. tl�rt yr.dr
m
Name oi nkutgagee or contract seller
�ceI V ao =�'�"D I • �l06-DO �
� Mortyape I Contraa in0ebcedness unpaid as of t,
w mntrad se0er (mm6ei and street �y: sbm, aM LP
Name of assignee w othu owner m holder af mortgaga
PddRss of assignee (numOer eM shee; Ciry, 51ate, an0
Dces epplit�ant own properry in any oNer
munry in Intliana?
❑ Yes ❑ No
D�duction approved in ihe amounc oE �
20 20
Yes. what count/�
ri�
I:T':^.:I
Yes U No
Is tl�e property in a�esbon: MnuaM <ssesstd
❑ Real RoPenY ❑ %�^�Y �
wnatTav�Disr f�l :11}'CI' 1�z
0....c��0°I. .. ..
COUNTYAUDROR C�l'(j 1�'O. ....�5�......
20 _ � �I U W . � _
Counry
I I We cerliy under the penatty of perjury Nat the above and (oregoing infortnalion is We and correct and Nat the appliqn[ is a resident of Intliana and
owner I contract buyer of the aforemelrtioned property on date applipiion is filed.
(number anC sLeef. dty, state, aM ZIP oode)
autliarzeE M dW1'rxearted Power of Atfortiey w Oy
Pdtlress ot auCwrved person (numDe� ar� sbeet ury, sfalc.
Date (monN. daY. lea�
Date (monlh. daY. Y��