HomeMy WebLinkAboutMortgage_Stunkelr^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
: FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (R71 / 6-a9)
1 P�ewiEeE by DepartmeN of Lacal GmemmeM F`ance
w.
NsrRUCnoNS: -
To be !!ed in person or by mail wiN the CountyAUd'ROr o� Counry Recorder ot tAe county where Ne pioperty is located.
Filing Dates: 7) Real PropeRy: Must file dunrg Ne year /or which the deduclion is soughf.
2J Mobde / Manufactured Homes not assessed as Real Property Must h7e dunng the hveNe (72) months
before March 31 0/ each year the deduction is sougAt.
See reverse side !w additional instrtictions arW qualifications.
Coun Auditor
8 d�� R�e�
t( orconvartbuyer-see m rsesde) GIBSON v V
COUNTy q�
Ta�dng oiSVitt Key rwmber I legal AeSCiplion Remrd numbpl Page .
- 3 - o� - 000. b y s-a-� 0 3 a3
Assessed rahe d real pmperty as of Mortuage / Coniraa'uWebtedness unpaid as d Mongage / Contracl cWebteMess impaiE as d s Ihe appGant the sde
M&rh 1. as`ent 1'� Mardi t. a�rtent year Eate o( aOP��^ legal or �Witahie oxTMR
Q ❑ Yes ❑ No
I( �a. what ¢ ha I her ezxt share o( interestt If ovmed wiN swnewie other than spouse, indimte wuh wfrom
It name m remd's E'ifiermt Nan Nat o! aPP�^� ��� �b'�' Is Ne poperty in Question: MnuaP/ Assessed
C�� �r O nm,�y w�a
�� a ��
contrap SeOer (mm6ei�rd stree4 �y. sbte, arM ZIP code)
rvame ot assagiee or omu owner w twmer a mongage
(num/�cer `a�rn suIeet a(ry�, JsereL, ana u�rJcoa'e�
^+'7�-�' ThT� U_O�E
uoperty any oNer If yes. whal
the amount of:
20
I/ We certify uMer Ne
owner / mntrad buyer
�na�ure(ownefs ,f re
p
V Full resiGen( addreas of ap�`iont (nu
� (i BYB M
Per'..on autlm�aed Dy d�dy ezecuteC f
Pdtlress of aNharrzed persan (num0
�
GOUNTYAUOROR
Di a�4•er NO.... c�� �,....
Card i\'O. ..,,���
�i�f U`bv. �2::....... o
20 _ 20 20 _ 20 20
Counry Date (mmrh. eaY• Y��)
that the ve and (oregoing infomiation is true and corteG arW thai Ne applinnt is a resident of IrWiana antl
ned p rty on date appliqtion is filed.
Date (nanfi, daY. YBaA
�
o(Attomey orby IC 61.1-12-07
'snee4 dry. sbte. aM ZIP ootle)
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