HomeMy WebLinkAboutMortgage_Chandler^'� STATEMENT OF MORTGAGE OR CON TEDNESS Coun Township vear
+ FOR DEDUCTION FROM ASSESSED VAL I�N� ��
`�"' ' Sta1e Fortn 43709 (R71 / 6-09) g
S 7 Presaibed hy DeV��n� of Lopl GovemmeM Finarxa
� File Mark
�vsraucnoNS: NOV 2 2 2p��
Fartn hled with:
To be filed in person or by mail wifh the CounryAudifor or Counry Recortler o/ the wunry wheie the property is located.
Fdirg Dates: 1J Real Property: Must 61e during Ne year (or which fhe deduclion (su:E��� � County Auditor
2) Mo6ile /Manufac[ured Homes rwt assessed as Real PropeAy: Must file dun he elve (72J months
before March 37 ot each year the deducfion is sou�ht ❑ Counry Recordu
GIBSON COUNTY AUDITOR
See reverse side for addifional insVUCtions arM qualificafions.
Key rumber / kgal EesaiPtion
,�/_�i'-r �—�-f'�'��- %%D
P.ssessed va4ie d2al PoO�Y as W ge / Contract indehted�ress unpaid a at MortgagA.LCmua(Y mAebtetlnrss �mGaitl as of Is Ihe eGP�t ihe sde
Mard� 1. armnt ytlr 7. w Sy�eq� �1 tlate of aPP�� legal or equitaCk ameR
UOSOV ❑Yes ❑No
if ro. what is his / her euG stare d interest? If awied wiM someone dher �han sPW�. indirate with wMm
It nartre m �em�d's dMerent than ihat of aPP�t mCicate bebw. Is Ihe property in questian: Mnualy Assessetl
❑ Real Roperty Q Mnually 0.�ea�
MoWle Hortie C 61.1-7
��a��a�,��� ��d ��.
Mtlress of mort9agce w contrad se0er (nurtiber ard streei, ray, state, arN ZIP code)
Name of assignee or other owner
AACress of assignee
_L�_- - _—__
�m
� Dra�verNO....�b�'....,... —
Card N0. ....�.��.......
I ��,5�v.� �
�..ry.4.�.� y�a� ry� �
1/ We certify untler Ue penal� of perjury Ne above arW fw
owner / mntrac[ buyer of ihe aforementloned property on date �
Pddress oi auihaaed persm (num0er aiM sveet, dry, state, and
F�U
Wl�at Tadrg D¢Uic[?
p
Has Nis detludion Oeen reQUesteE m G�Y
fOf Wrt2f1t `fP2(.�
❑ Yes ❑ No
� � �
iniwmatlon is We and corteG and that Ne appli�ant is a resident of Irdiana and
ian is filed.
// v
Date (rtmfh, day, ysah
Date (monN. daY• YEa�