HomeMy WebLinkAboutMortgage_Hill (3).f °"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C u T ip Year
� FOR DEDUCTION FROM ASSESSED VALUATION
. " .' Slate Fortn 43709 (R8! 2-07) p
S y,. � Presmbetl by Departmen� of Local Govemmmt Finance Q r 2 9 2008
� Fil'e�Mark
INSTRUCTIONS:
To be filed in person w by mad wdh Me CountyAuAitor o) flre cowty where the property is located.
Fd'a,g Dafes: 7J Real Properfy: Dunng the 12 months be/ore June 77 0l the year Ure deduction is to be e/fecGve. GIBSON COl1NTY AUDITOR
2) Mobile Homes assessed under IC 64.1-7: Behveen January 15 and March 2 0( the year the deduction is to be eifeitive.
See reverse side (w additional insbucGOns arrd qualifications.
(owner w mnhacf 6uyer - se� s�fions m reverse
Taun9 DisUicl
S
Aaessed ralue of re� papaly as d Ma`rh 1. artenl ye�r Mortgage I ConUaG udabtedness unpaid as of March 1. Is ihe app5canl Ihe sde legal w equitade owne(t
GuRenl �
❑Yes "❑No
IF ro, whal is his / her exad share of interesl? If owned with someone dher Ihan spouse, indiwte vnih wMm.
I�e on recortl is d'Aterenl ihan thal of applicanl, indiple 6elow: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.
Name of mortgagee or canlracl seller � ��� -`
V
Adtlress of mortgagee or mn�rad seller (nurnber aM s6eeG dty. state. and ZIP code)
of mwtgage
assgnee (mimber and sGeel, dty,
Does applicanl wm property in erry olher
counry in Intliara?
❑Yes ❑ No
approved in the amount of:
��25�1
1.
' Drawer NO .�t�, ,0.: �96.�
n CaCCI �i �,�, ,�....
�U-C4m/ �'� �;OUi:'ao
2p � 20 _ I 20
Counry
Has Uus deduclian been requcsted on property
ror a,rtent yean
❑ Yes ❑ No
20 20 _
Date (monlh, day, yeaQ
I/ We certify unCer the penalry of perjury that the above and foregoing infomiation is we and mrred and that the applicanfs was I were a resident of
Indi�a and owner oi the afwementioned property on March 1, 20 _
�
�,y
dty. state.
pasan (num6eiand s�re�G cdy. state, aM LP wde)
Date (mrnth. day yea�
Date (rtrnth, day, yea�