HomeMy WebLinkAboutMortgage_Heuring^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
l.� �' State Fortn 43709 (R71 / 6O9) .
�` � Pawibea by oepartrtrent ot Local Govemment finance
File Mark
� srRUCnonrs: JUL 2"F �m:
To be lled in person w by mail wiN the CountyAuditor or Counry Recorder of the county where the property is located.
Filing Dafes: 1� Real Property: Must file during the year fo� which the deduction is soaght. C ^ � County Fwdrtor
2) Mo6ile / Manulactured Homes not assessed as Real Properfy Must fiie dunng fAe twelve (12) monffis
6efae March 31 0/ each year the deduction is sought Counry Reoorder
Seereversesideforadditionalinshuctionsandqualificatrons. GIBSONCOUN ITOR
Ap�ont (owneror a r- see resUrliorts oy�rerse ) / /
���� J`-�" Q/YUr n .CV� ii n i m�.
mm�Eer
V'J7/I//l/ry/lw la(L�J—
0.sesseC �ralue d real P�PenY a d
Ale�ch 1 � aam�rt 1'�r
tt no. what Is his / trer e�1 share W int�f?
If fwne on �em�d is EiHUent Nan Nat of aPpG�
Name af mort9a9ee « mntrarl se0er �
nnaress or �,ony��
Name
Mo2qage I Cantraa iMe6tetlness
Mamh 7. ar2nt year
spAer (nuniber and sLeet ciry. sfate. ard ZIP
owner w hdder d mortgage
(num6er aM stree4 mY. sbfe,
epptirant rnvn poperty in any other
vin Iridiana? � _.
Detluaion app�oved'o� the amount
20 _ ' 20
Signature of
If yes. whal counly+
�o�
20 _ 20
Page numbrl
as W I Is Ihe eOP�irant Ne sde
�egal ar equRade awnel.+
❑ Yw ❑ No
snmeone oihe! Cun s7a�. indkate wNh whom
Is ihe p�operty in 0���: A^nualty Assesse0
� Real PfoPeKY ❑ ?n^�a��Y P�
N�,¢�`'�,
What Tr
N
CL���
SA� � o �
ia-3�c�� —
� �
Date (rtmth, day, yea�
I/ We certify under Ue penalry of perjury Nat the above aM foregning infortnaGon is We and cortec[ arM ihat Ne applirant is a resident of Indiana and
owner I mntrad buyer of the afaementioned property un date appliplion is filed.
Nawre (owqen/utlname).. ( Data (morAh. daY.Yea�
� � � A1
M ezetutetl Power
tlry, state. aM;
���7
a�ttror'¢ed person (numberald sbeet, ciry. sbte. en0 ZIP code)
Date (mon(h. daY. Y��)