HomeMy WebLinkAboutMortgage_May (6)'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
_,_ ; FOR DEDUCTION FROM ASSESSED VALUATION � g g
State Fortn 43709 (R77 16-09) N ��
�' ,.,. � PresrnEed by DepartmeM of Loml Govemment Firence 1 JLJ
Fle Mark
NSTRUCTIONS: �EC q p Z��� FormAedw�h:
H 7
To be filed in person w by mail with fhe CounryAuditor or Counry Recorder o/ the counry wFiere th property is located.
Fi7ing Dates: 1) Real Pmperty Must file dufig the year for which Ihe deduclion is sought. r, ,�'r� � County Auditor
2) Mo6de /Manufactured Homes not assessed as Real Prope�ly Must file dunng the-fwerve � l��
be(ore March 31 o/each year Ute deduction is sought. ❑ County Reoorder
Seereverseside/aaddilionalinstructionsandqualifications. GIBSON COUNTY AUDITO
AppGC�t (owne�oroontrarl6�yer- see resbirbms on rererse siCe)
{�
year
If no, what's his / her esact share of interest'�
It riame on mmrtl is 6Rerenl Nan Nat of appfiran4 mdKate be�ovi:
Name ot mortgagce « mntraa seller �
�
Address of rtiortgagee w mntraa setler (number aM sbee4 ci(y, sbte. aM Z/P code
Name of assignee or oNer owner or holder of rtqrtgage
AaCress o! asti9nee (num6ei arM sbeef, dN• ��e, aM ZIP cotle)
Oces aDW�nt oxn property in any oNer If yes, what munty?
counry in Indiana?
❑ Yes ❑ No
COUI
DeducOOn apprwed in Ihe amoum ot
20 20 20 20
Remrtf number
unpaitl az U I MMgage / Contrar3 mdehtetlness unGaid as of
date of appGCation
spouse. indwate with rlwrn
Page number
❑ Yes ❑ No
Is Ue property in puestion: Mnually Assrssed
�Rea�aroaenv ❑nn�ua�yassessed
o f. � ...... -
WhatTaarp Dra�ver NO..�. I!•�• _
lY ��I�:.l...... uo
CaCCl iVO. ......... _
\UDROR �'h'],M/� e � _
�� �J�ni
<V
Date (monih. tlaY• Yzah
20
I I We certify u�er the penalry of perjury that the above and foregoing infortnalion is true antl corteq and Nat Me applirant is a resident o( Indiana arM
owner I mntrad buyer of ihe aforementioned property on date applicabon is filed.
7fanve (owneh Ntl name) Date (monfi. daY• Yea�
Pelson autlo�¢M Cy Cuty esewtetl Power o(AtbrrieY or by IC 61.7-12-0.7
author¢e0 person (numberantl sbee4 cify. sbte, aM ZIP
oa� (rr,wvn. aay. r�r�