HomeMy WebLinkAboutMortgage_Davis� a �3
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
:�__,_ ; FOR DEDUCTION FROM ASSESSED VALUATI� ���
Smte Form 43709 (R77 / 6-09)
S,�,� � Presaibetl by OepartmeN af Lo�l Govemrtrenl Fnance
File Mark
wsrRUCnoNS: AUG 2 4 Z�»
To be fded in person w by mail with the CountyAUditor or Counry Recwder o/ the county where the property is located.
Filirrg Dafes: 7J Real Property: Must !!e dunng fhe year for which the deduction is sougA(..
2) Mobde / Manufactured Homes not assessed as Real Property: Must file dunng�fhe fw ( months
betore March 37 of each year the deduction is sought.
See reverse side fmadUi6onal instructions andqual�cations. GIBSON COUNTY AUDITOR
I nppGcant (o�mer w,qu�traG buypr- see�MCnbns �'�everse side)
( �10-7 ��XJilrn♦
legal desaiption
If rw, what is ha! her
It �wre m reCOtd "6 OHferA�� Nan tltat of aPp6taN, uWitate belmr.
Name of rtqRgagee or mntrscl se0er
Y�
���
ier and streeG crty, state,
mortgage
Fwm filad with:
,� CountyAUditDr
❑ County Recorder
000 lJ�d -Q� �umber Pagenumbu
ss unpaid az af Mtutgage I Contrar] iMehtednass unpaid u d Is Ne appliwit Ne sde
�1 date of appGCation legal or eQUitahle mmeR
/ ❑ Yes ❑ No
If ovmed wiM someo�re other ihan spouse. indicate with whom
naaress o� assgnee (nurwer ana suee4 �Y. s+are, ana ur ooae�
Dces apd� � P��' in any aNer I( yes. what count�t YYhat Tarir
munry in IMena?
❑ Yes ❑ No �
COUNTYAUDROR
Deduction approved in Ihe artroum ot
20 20 20 20 20
Sigfanue of CamtYAUERnr Counry
IS CIC WOGQnY T GIICSLOfI: MIIIIdM A4CSSl�
� �v�M O ��, ��
Moale Hon,e nc G,.
.Q(�"�, C1a��.. S
i � -a �� 3
20
Date (month. EaY. Y��
20
I I We certify under Ne penalry of perjury that the above and foregoing intortnation is We and cortea and that the applirant is a resident ot IrMiana arM
owner I mntrad buyer of ihe atorementioned pmperty on date appiiratlon is filed.
�rature (ox+�erY fiAreme) Date (rtmCi. daY• Y��l
tl/ry', sfate. aM yLP oo/tle) �����
NlAA �A/'Aw/�/ 7,//•
Person auttpr¢ed Gy G�dy executetl Pwrcr of Attomey m by IC 61.1-12-0.7 � I Date (manth. tley,
AEtlress of author'¢eC person (num0er arM sbce{ ciry, state, end LP cade) _