HomeMy WebLinkAboutMortgage_Adamson (7)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
• Smte Fwm 43709 (R71 / 6-09)
S � Prewibed by Department ol Loral Govemment Franca
Fi� M k
INSTRUCTIONS:
To be fiied in erson a b maii wdh the Coun Auditor or Coun Recorder o/ fhe coun where Ne F� �'�I '���q g �f1�tl
P Y b �Y � P�PertYislocated. �}�+`C,oHntq'Addit4k�
Filirg Dafes: 1J Real Property Musf fite dunrg the }rear /or which !he deduction is so ht. LJ
2) Mo6ile / Manufadured Homes rrot assessed as Real Property: Must file dunng fhe fweNe (72J months
6e/oie Mamh 31 0/ eacA year the deduction is sought. ❑ Counry Recorder
See reverse side for addifional insvuctions and qua/ifications. '�' �.
nppfca ( ormntraebuyer�seere � mm�erse � GIBSON COUNTY AUDITOR
Ta Key ber / legal desaiption Rem�d numt� Page numbu
_ o - _ 00% - � a 60 ��/n
vWue aF 2a1 pfopelty as d Mortgage / Cantracl indrbtedness unpaid as of Mwtgaga / ConSact mdehtedness unpaid az d Is Ne appGrant Ne sde
' 1. o�m¢ year MamJ� 7, artem year d f aPP�� legal w eQUVade ameR
f� ❑ Yes ❑ No
If ro. what a his / her e�wt shara o( intsrst? If owned with someorie other than spouse. G�d'xate wttA Mam
It nartre m remrtl's dRler�t Nan Nat of applkant, mdinte bebw Is Ihe property in Questirn: MnuaOy AssessN
❑ Real ProPeKY ❑ ���Y�
blobile Hm�e IC 61.1-7)
Name ol rtwrtgagee or mntrarl se0er /J
C
Address of mortgagee w mntract seller (number end 4 �Ri:.state. aM ZIP code) �=
Name of assignee a oNU ovmer or hoNer M mortgage
i ^
AEtlress af assignee (numDer ard snee4 u+Y, s/ste, and LP cotla) ��l \ ,
4�
DDes Bpplifant v+m pmperty in any oMer If yrs. what couni�/? NRat Ta�drg D� D r a��� er ��' �� ��
munryinlMiana? ...•
❑ Yes ❑ No �a-.,.••' '
COUNTYAUOROR C.1Yd,qa��.� � .. -- � ;
Detluction app�oveE in Ure amount of. � �
20 _ 20 _ 20 _ 20 2l1 20 20 _
Sigriature N Camry AW imr County Date (monfh, daY. Y��)
I/ We certHy under Ihe penalry of perjury that the above and (oregoing infortnation is We end cortect arW �hat the applinnt is a resident of IrWiana aM
owner / mntrad buyer ot mentioned property on date applinlion is filed.
nue (o�me/s hN na Date (rtcnM. daY. Y��
�7L-b'J7�- � ��
'Fi11(reSiEent address ol appfront (wmber antl sLee( dry state, aM ZIP mde)
lC�(D . 3.`� L �hs { �'
Pefsm auUrortred Oy duty esecuted Power W AuaneY a M IC 61.7-12-0.7 . Date (monN. dzy. ysa�
PdCress of authoraeG person (number aM streat �: sbte, aM LP cotle) .
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