HomeMy WebLinkAboutMortgage_Parke-✓.'
^�n STATEMENT OF MORTGAGE OR CO�
_ FOR DEDUCTION FROM ASSESSED
• State Fortn 43709 (R7116-09)
� t Piewibetl by DepartmeM of Local GovemmeN Frerxe
wsrRUCnoNS: JAN 3 2012
To 6e filed in person w 6y mai7 with the Co�ntyAuditor or Counry Reoorder of the oounry wh�2 the p.�r y is located.
Fi7irg Dates: 1) Real Pmperty: Must file dunrg fhe year /or which the deduGion is soughtL � �� �
2J Mo6ile /ManuFactured Homes rat assessed as Real Property Must h7e dunig the M1vet�e ( nths
6eforeMarch3lofeachyearthededuclionissought GIBSONCOUNTYAUDITOR
See reverse side 7or ad�lit�nal instmctions apc�qual�wtions.
A� vdhe rf real qo0em/ a
Mart{� 1, qm`ni yYar
what's hs / her e�cc share of interest?
on remE is tlMemnt Nan Nat o/ appBmn�, intlinte bebw.
rt�oetgagee or contract
Aildtess U ^qrt9a9� or wnbad
Nan
�� Dra�ti�er NO. a��.�/1........
ar Cai�d �'O. ...y%�5........
— C�NC3 � 17d, cbo. �'/
Deduc6rn approvev e� �.� ....._ _..
20
1/ We ceNfy urlder Ne
owner I contract buver
20 � 20
of perjury
above aM
�erty on da
unpaid as of Mortgage / Contrart mdebtetl�s
,,,� T Eate of appGCation
it�? I VJhat Tanrg Dislrir2?
COUNTYAUDROR
20 20
. �^ty
11 reGCent atldress ot appliont (numDer antl sfreet, city, stafe, antl2/P ca
Zy9yS /2ooE ��k.�
Person auNOised EyCUty executed Power N Atlm�ey or by IC Gt.1-72-0.7
PdCress of authwaed person (number aM sbeeG dry. s+ate, and LP mtle)
File Mark
Form fded wtrh:
Q,�6earrt�Auditor
❑ County Reoorder
��
as of Is Ne ap�t tlre sde
legal w equiiade owneR
❑ Yes ❑ No
Is the property in Question: MnualtyltsesseE
❑ Real Property ❑ Mnually 0.ssessed
Has Nis tleCUUim Deen reVUested m pmperty
for wrren� Yea�? ❑ Yes ❑ No
�
Date (rtunM. daY. Yea�
20
infortnalirn is true and correrl ard that the applipnt is a resident of Irdiana aM
ron is filed.
Date (monfh. day, Yeah
r�, y� ��6
oace c�.w. aar. r��