HomeMy WebLinkAboutMortgage_Holey"�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u hip Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
. r State Fortn 43709 (R7716-09)
�` yw � Pr¢soibed by Department of Local GovemmeM Firence
AU Fi �
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To be lled in person or 6y mail with fhe CountyAuditw or County Recorder o/ the munty where tl�e pmpeny is located- �� �n �
Fifirg Dates: 1J Real Pmperty: Must file durrng the year (or which the tleduction is mught. �unty Auditor
2) Mo6ile / Manufactured Homes not assessed as Real P/operty: Must h7e dunng the twelve (12) months �,U�dS�R eco�du
beforeMaich3lo/eachyearthedeductionissought. GIBSONCO N "R
See rnverse side for addtional instructions and qualifications.
7g � isp p� � Key numher / legal �saiPtion Remrd rwm6er Page numou �
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pssessed vatue d real paperty az W Mortgage / Contract iMehtedness unpaid az o( Mort9a9e I Contract mdebtedness �mpaid es o( Is Ne epplkant Me sde
MarM 7. aereN Yqr M2(rli 1. wrtent year Eate oi aOP�GOn �egal or e9udable owne(1
S� D D D ❑ Yes ❑ No
n m_ Wut is h's / her erart share of inte`est? If awned vrith somea�re other Man spouse. irdicate wtth whwn
If reme on 2coid "s dflemnt ttun Nat o( ap{�ipnt. 6dipte bebv!
mort�ageeormnNaGSeller �_ /�
W rtnrtgagce or mntrad seAer (num6er aM stree4 ��Y, sfate, aM LP code)
Name o} assignee w otlrer ovmer or holder of mort9a9e
MGren olgsvgnee (number arid streel, rdy, sta.e, an0 LP ootla)
munry m uqana r
oaa��oo� evw� m u,e
zo _
any oNer I If yes.
Yes ❑ No
�
I I We cert'rfy urWer the penalry df perjury
owner I mntracl buyer ot lhe aforementic
Is Me ProDenY in VuesUm: MnuaPJ AssesuW
pri�i a�ocem ❑ aJn,uanynss�sea
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couNn nuorroi
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Caunry
a Oy IC
pereon (numberaiASbee4 ciq: slate,
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/02 -a 9� 8
day, yea�
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e ard (oregoing infortnalion is true and mrtect atW that the applirant is a resident of Indiana arW
an da[e apD�ication is filed.
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