HomeMy WebLinkAboutMortgage_Stout"'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C u" sh Year
7�__,. ; FOR DEDUCTION FROM ASSESSED VALUATION '
State Form 43709 (R71 / 6-09)
� � Pr¢soibed Ey DepartrtieM al Loral Gavemrtrent Frence
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INSTRUCTIONS: F� �� �_
To be filed in person w by mail with the CounryAuditor o� Counry Recorde� ol the county wheie tAe property is located.
Fifirg Dates: f) Real Property: Must file d�rrrg the year (or which the deducfion is sought. � ¢ounry Audimr
2) Mo6ile / Manulactured Homes rrot assessed as Real Property Must file during the hveNe (72) months �h���
6efore March 31 oleach yearthe deduction is soughG GIBSON U �
See 2verse side fa additional insWUions arM qualficafions.
MP�ni( haUbuyE�'seel€�mcna�sM�'f¢4�a) � / . � i.
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/ her e�mU snara ot intrlestl
m �emrtl's QAemnt Ihan Nat of a00�• �inte Eebw.
Nartre M mort9a9ee or mntract se9er
Name al assi9�ee w
mortyage
sta�.
>t asUgnee (numOer aM slree{ dry, stale, and Z/P catle)
lirent ovm property in any oNer If yes, wfiat
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❑ Yes ❑ No
DeducCOn apyoved in tlre amount
20 _ 20 ,
Sigrenae d Camb nueiwr
2Q
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intlebtedness unpaid as of Mortgage / ConYarl
r _ � aate of ap�cation
If owned with someone oiher than spouse,
code)
COUNTYAUDROR
20 � 2b
Counry
RetarO number Page nu
UO 9 .� �
unpald as d Is Ure appfi�nt Ne sole
legal or equifaWe ameP
�Yes ❑ No
I perty in QueSGOn: Mrn�a%ASSes5e0
Real Roperty ❑ ArmuallyAssessed
Mobile Fiarie (IC 6
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I/ We cerofy under the penalry of perjury that Ihe a6ove arW foregoing infortnation is We and cortect arH Nat the applipn[ is a resident of Indana arxi
owner I contract buy f the a(oremerrtioned property on date application is filed.
maWre(awners hd nam _ Date (monfh. daY. Y��
of a��T(numberand shee( tity. stat�. and ZIP mde)
w Dy IC bi.1-12-0]
person (number aM street. crry.
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