HomeMy WebLinkAboutMortgage_MerchantSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T p ear
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fartn 43709 (R10117-08)
� �� Prescribed bY DeGaMrenl d Local GovammaM Finano
�NSTRUCiIOnIS: Fle MaAc
To be filed in person or by med wi7i fhe CouNyAWitor d fAe county where the property is located.
Filing Dates: 1J Real Properfy.� Musf file during the yee� /w which the deduction is so�ght. �-//��-r(�
2) MobDe / Manulxturetl Homes irot essessed as Real Property: Must file durirg tl�e tweNe (12) monfhs be7ae ��01 year
rhedeouct;on�sswynt. GIBSON COUNTY AUDITOR
See reverse siae !or edddfionel instnidions and 4�lificatians
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T' g Dishid . Key number / legal tlesviptioa Remrd number Pape numbar
aG- - � 9- �oo-ooi. �SQ -oo � 0 aS
Asms.ad v�ue d`aal praperty as d MMpape I Cmirap uWe6(eEness unpaid as d Matgage / Con�2q inEebtedness unpeid av d Is Ihe appifaN Ne sde
March 1, amaM yea MaRh 1, umem y�r . dale o( appGrrtion legal ar equitabla w�rie(1
pZ �Q d Q ❑ Yes ❑ No
7 ro, whal is his / �a emd share d iinaresYl G wrtied with saneone olhx ihan sP�. �drate rilh Warn
tl reme m recad is C�9arem �han that or avo�. uMkam balo�r. !c the moaeM in aue5ion: nfmuaM �.ssessed
❑RealProperty QMnuallyASSesseC
Mohila Hare IC G1.1-7
Nama d mortgagee v cantracl seller � �. �
�%
Address ot mortpapea or rnrirad saDer (rtun6erand st+eel �Y. ifate, and P wde)
Name d assigree w othx o.mer or hdder d rtirniBaGe
Pddress of ssipnae (mi�rMe� and sbceL M: ffifi. aW LI
Does applimnl wm paperty in am/ alher tt y
�rcy �� i�e���
❑ Yes ❑ No
DeOUClian app�oved m Iha amouM of:
20 2� _ 20
P
Sipnature d County Auditar
T�
COUNTY AUDITOR�
20
M�c�c��', �ost7'r� F i No
[A u,e� � —
o�-a� y
�Y. Y�)
I/ We certify under Ihe penalty af prljury ihat the above afM foregang mformation is We and cared and that �he appOCant is a fesiaent af Indiana and
owneil mnt2d buyer of the aforementiontW poperty on date application is filed.
snoN. riA: ata�. ard
�C 73/S
Peisrn auUrc
Addreu d aNhaized persm (nvnLC/and 5tred, tity, ffilo, anG LP cado)
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