HomeMy WebLinkAboutMortgage_Baker (3)"^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ s FOR DEDUCTION FROM ASSESSED VALU�� ��
• State Fam 43709 (R71 / 6-09)
S � PreunEeE by �epartmeM of Loral Govemrtrenl Fifance
w File Mark
rvsrRUCnoNS: FEB 1 3 Zp�Z
To be fiied in person w by mail witlr the Counry Auditor or Counry RecoNer o! the counry where the property is located.
Fi7irg Dates: 7) Real Property: Must file durirg the year (or which fhe tleduction is swyht��w-�t—
2) AbbBe /Manulactured Homes rat assessed as Real Property MusY'fi7e dunny7ns'�2A�e (72) rtwnths
6elore March 37 of each year fhe deduction is sought. v V
Seereversesideloradditionalinsmmtionsandqualifications. GIBSONCOUNTYAUDITOR
AppG�am (o o� hact buWr � s r!Slrq�s m rete/6e sAel � _ . il
�Y
������
share ot interest?
if�-i'-ri��S. *..
Name of rrortgagee or mntract seller
Fortn Aed witA:
�Counry Auditor
❑ Counry Remrder
- ` �-d.�l� =aoa-6 . a6o-�a __or� � 3 -
Almtqage / ct iridrbtedness unpaid as N Mortgage / Contra`] iMebtetln¢s �mpaiE as of Is Ne apptirant ihe sde
March 1. Eate of appGCation le�l a eWitEGe ownM
O O ❑ Yes ❑ No
If owned wiN somew�e other fhan spouse. iMicate with whan
AEdress o1 rtwrtgagce or mntrad s�er (mm6er and streeFarty, statA. aM ZIP roda)
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20 20 20
SignaWre W N_A i r �/� _ �^
nunry? I WhatTabrg DisUic[?
COUNN AUDROR
20 20 _
" ' � �nry
I/ We certify under the penalry of perjury that ihe above and k
ovmer I mntract buyer of Ihe aforementioned property on date
(numDer an0 street, ary;
or by IC Gl.t-12-0J
Pddress of aNhor¢ed person (number aM sbceG ciry, slate. and ZIP code)
Is the property in Questim: Mnualry Assesse0
❑ Real Propenr Q nm,ua�yAssessed
Has �his deductim Deen re0uesteE m O�Y
r� a�n y�r.
❑ ves ❑ No
20 20
n^'o (rtmfi. tlaY• 1'��
infortnation is We and cortect arW Nat the applicant is a resitlent of Indiana aM
ion is filed. �
Date (n�N. day. yae�
Date (monfh. tlzY• Yeah