HomeMy WebLinkAboutMortgage_Eppersona^^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou s' ar
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (RS! 2-07)
' 1 F'resm3ed by Department af Local Go�emmart Finance
Ha
wsrnucnoNS:
To be filed in person or by mad with the CaurrtyAudi(or of the courtty wheie the property is bcafed. `-yy�
Fding Dates: 1) Real Pmperty.' Dunng the 12 monU�s 6efore Jurre 11 of fhe year the deduction is to be effective. �'( �
2J Mobila Homes assessed'mder IC 6-1.1-7: Behveen January 15 and Maich 2 0/ the year the deductim is to be effedr�
Seereversesideforadd'NOnalinstructionsarMqualificafions. � GIBSONCOUNTY.AUDITOR
Applicarrt (amra or mnhad buyer - see res4ictiats m reverse sde)
�'
T'rg DiSrid Key number/ l desaiption
r _ �• _ �(o _(( Od1 �
Assessed vahie of mal popary as af Maich 7. ameN Y� �9a9e / ConVact rtWe
� airre�rt� //o(v
C
m reard is d'Alerenl ihan Nffi of applicanl, fndimta below:
Name of rtahgagee or mnllracl sdler
Address of moAga9ee « mntrad sdler (nwn6er and streeG oty. sfatb!arM LP code)
Nama
IX
ar�d s4ee1, cify, stafe, and ZIP cotle)
Dces applicaN own property in arry other If yes.
county in Indiare?
❑ Yes ❑ No
�
apprwed in Ne amwnt of:
20 � 20
az
Record numba Page nwnber
_ 00 a �'
,,,. �s�,a�,w��,t��a���«��we��,
❑Yes ❑No
If owned wilh sort�eone olher �han spouse. indicate
Islhe propertyin
❑ Real PmpeA
�C SU IU � �
EpP m� csss� �
❑ Mobile Home
wr �Z,1'JE11 F�'Lp
sf/kf'� ��,UIC
��.�G���o .� � pc9 - `F18'
COUNTY AUvi � vrc
�
County
20
20
;�� a� nw�r
I Yes ❑ No
20
1/ We certify under the penalry of perjury ihat Me above and foregoing infortnation is We and correcl and ihat the applinnLS was I were a residen[ of
�ea and owner oi the afwementioned property on March 7, 20
(mme(s MI nartre) � Date (montli. daY• Y�/)
state,
exewted Power of Pltamey w bY.IC G1.1
Addrrss of auUmt¢ed pssan (mmbe alM sVeeG rdy, state, a� Lli' wtli
� ,. . 2 n .
Dale (mmth. day, yea�