HomeMy WebLinkAboutMortgage_Pinnick"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS vear
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R11 / 609)
�' PresuiEed Oy �epartrtieM ot Loca1 GovemmeM Fi�nce
File Mark
wsrRUCnoNS:
To be filed in person w by mad wifh the CamtyAUditor or Counry Recorder of the county where the pmperty is located. O V �� ��
Fi7irrg Dates: 7) Real Property: Must file durirg the year for which the deduction is mughG �Counry Audimr
2J Mo6ile /Manufectu2d Homes rat assessed as Real Property Must file dunng the tweNe (12) month�p '�
belore March 37 o)each year fhe deduction is sought. �^�Y R��
See reverse sieeJe�edditional instructlons and qualifications. GIBSON CO
A� vahc af real property az of
Ma�U 1. anatt 1tlr
�(!q. W�1316 �16 � h2f 0I2Q S�IdfB Oi Il1iEIPS17
r�ame a, �«a �s am�c wo m� or eppowm. �a�m
�.r �
/ Cantract IndebteO�ress unPaid a of Mongage / Cm7aU'vMebtedriess un0� as d Is Ihe ePW�t iho sde
y�p�t y�a� Eate W appfration �gal O e O
o( SL Yes No
ff OWfIBd V/I11150f�CO�E Od1M I�tHII 5ppLL52. Illd ^1.218 `k�I�l W�1OT
ALdress of �ratgagee w mntract seAer (nurti6� end sheel, cGy state, arM LP code)
Name of assignnee w oCrei wmu w hdder af rt�ortgage
AGaress or asagnea (number aM street �Y. stete.
�oes epptinm o.m yoperty in any other
munry in Indiana?
❑ Yes ❑ No
Detlucfion approved in Na amount at
20
Signahrte W CambNiOitcr
p- � �-
I/ We certify urWer the penatty of
owner I qx�traU buyer of the afon
COUNTYAUDROR
Is Ue D�cenY in Question: Mnua%ASSes^,ed
❑ R� �roaertr ❑ �N wss�d
- o2p�D......
pt-:l\\'Ci' \�............
�o....�D�'�......
Catid {,
� I�'�,'��' ��
�_ � p_
Counry
20
��
i;�]
No
that the ahove arW foregoing intwmation is W e and mrtect aM Nat the applirant is a resident of InEiana and
ned pro on date aDWiption is filed. �� . .
Date (rtrmtli. tlaY. Y��
rify, stafe. antl IIP code)
�ate (monlh. daY. Y��
PdCrass of auCmr'¢ed puson (numOe�aM SLee; cdy; SYdle. end Z!P oode)