HomeMy WebLinkAboutMortgage_Simms"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 7 hi Year
; FOR DEDUCTION FROM ASSESSED VALUATION
Sta[e Fwm 43709 (R77 / 6-09) �
,' 1 Presaibed by DepartmeM of Loral GoremmeN F�unce
File Mark
INSTRUCTIONS: O C T F�
To be filed in person w by mail with the CountyAuditor or Counry Recort/er of fhe counry where the property is located.
Fifirg Dates: 7) Real Pmperty: Must file durirg fhe year for which fhe deduction is sought. �, Counry Auditor
2) Mobde / Manulactumd Homes nof assessed as Real Property: Musf file dunng (he fweNe (12J monfhs� �„ �..,,
6etae March 31 of each ysar the deduction is sought. a Q �nty Recorder
See reverse side (oradditional inshuctions and qualifications. GIBSON C�„ .. �
I Appf�m (owner� oontraa buYer-/Cfe �esmrLOr�% m rerwu site)
oisma
-0�00 -DDO, ��O - 00
aa'udebte0ness unpaid as of Mongage I Cor
year date of appGtal
7 n /7 (7
�s na r ne� �a
�Y fume m mmN a NRereni Nan Ihat W app�anL kWinte Eebvr.
Name ot mortgagee or contract seUer �
Address of rtart9agee m m�tract se0er (number end streel, rdy, sfafe, aM LP coda)
ditant ovm property in any oNer
Intlana?
❑ Yes
De�uction apprwed 4� Ihe artpuM of.
mortgage
slate, antl ZIP code)
If yrs, what wunt�?
I No
20 � 20 � 20
I�N�e W County AuEitw
�
1/ We certify der ihe penalry
owner / mntrad buyer of the a1
�rew2 owne/shAname)
A resident a0d W aDpfrcant (nu�
20
I�l a
ff��������.�����,
Y� u No
Is C�e P�«1' m 7urslion: MrwaOy Ass�sed
❑ Rr.W P�operty p �vn,uany Asessed
� . r.�..r.ae �....,e nr a
w� DC��1'CI' ��D.CaC(,�„l9.........
�� c��-a ��o. ...3 ..............
_ �ro,000. °°—
Date (monM. daY Y��
6i
that the abore ard foregoing in(wmalion is W e and cortecl and fhat the applirant is a resident of Indiana and
property on date application is fil
Date (month. da . yva�
„ 1� . __�_ / � o %.�/„�
Person authoraed Ey qily ezecut d Power f AttcmeY � M IC 6� �� I Da1e (monN, EaY. Y��
�X 1 �710
Pddress of a person (numbes aM sneef, tiry, sta , eM LP code) .