HomeMy WebLinkAboutMortgage_Baker_ NSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
: FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (Ri1 / 6�W)
�• l Presr+ibeG M Oepartrterd of Local Govemment W�ance
,w Fi rk
�STRUCTIONS:
be filed in F� � �:
person or by mail with the CountyAuditor or Counry Recorder o! the oounry where the property is loca(ed.
Fifing Dates: 7) Real Property: Must file dunrg the year for which the deduction is sought � T�����
2) Mo6�7e / Manufadured Homes rwt assessed as Real Pmperty Must file dunng the fweNe (12J monfhs
be(ore MarcA 31 o)each year the deduction is sought. �, �ef
See reverse side !or addiUOnal inshuctions and qua( fions.
App&anl(ownerorcontrarlbuyer-seeresfrirbonsmm sde) .� � � GIBSONCOUNTYAUDITOR
-,
As�sedvahredrralPW��Yazd �9a9e
March 1, amnt year
I( ro. whal is his / her exaU sha�e of interest?
If name m remN is QAiemnt than that W applirant, irMirate
Name of mwtgagro or conbaG sHler
Address of rtnrtga9ce w canbact se0er (number arM stree4
Name af azsignee or
mortgage
-ioi (� a 3D � a-a y ��°b; ��,
az af h Ihe ePP�� the sde '
kgal a epuilade oNmll
❑ Yes ❑ No
_. I rc ownetl wiN wme�re ottrer Man spouse. ind'xafe wNh wham
6ebvr. _ �li �L-y� fi ^�� /� nYinquestion:Mnua➢YAsesse0
�'lll �J� I.� oPertY �� � Assessed
Jt"7ViV1,�,� ,D
��. te,: II —��i��
ray, slate, and Z/P code)
Does applifaM oxn praperty in any olher I If yes, what toun�?
counry in Indana? ❑ Yes ❑ No
Deaucfion approveA u� ihe amount
20 _ � 20
$igretlrte of CainN AudRw
20
Ivmei r��q orsu;az
COUNTYAUDROR
20_ 20_
—�COUnp'
for arrent yean
�
Date (rt�orVh.
repuesteE m G�W�rtY
❑ Yes ❑ No
Pa�7
I I We certify uMer Me penalry of perjury that Ihe above arM foregoing intwmalion is We and correct a�M ihat Me applirant is a resident of IMiana and
owne contract buyer of Ne afwementioned pmperty on date appi&ation is filed.
i o fiAreme) n /1 /% /l Date (nmfh. daY.Y�a�)
Person auNO�¢ed Dy dWy esewted Power o( FUtomey w q IC 61.1-12-0.7
Pddress af aWq�"ve0 persm (numberaM sbeet �: s�afe, and ZIP cotle)
�� (�.��Y. Y�)