HomeMy WebLinkAboutMortgage_Bengert (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C 7ownship Year
: FOR DEDUCTION FROM ASSESSED VALUATION
•,.� _.. • Sta[e Form 43709 (R71 / 6-09) �
,� 1 Presaibed by DeP�reM ot Lo�al Govemrtrent Frence
�"' File Mark
�srRUCnoNS: APR
,:
To 6e filed in person o� by mail with fhe CountyA�ditor o� Counry Recorder of the county where the property is located.
Fifirg Dates: 1) Real Pmperty: Must file dunrg fhe }rear (or which the deduction is sought. C��. Counry Auditor
2J Mo6r7e / Manufactured Homes rrot assessed as Real Property Must fi!e dunng the fweNe (12J monfhs
before March 37 ot each year the deduction is sought. unry Recorder
GIBSON CO
See reverse side (or additional instructions arM qualificatans. ��r
AooGranilowneror bYYer-sear457rk'tionsonreyer�eside) �
����
�•F^;ar.r�r�,a^��a
It �a. what fs ttis I ner eza�1
�
/
Nan Nat o1 app5mnt, om0ipte beb�r.
o( nrongagee or crntract sN�er
Atldress of �mnJa9ee w mntrad se�er (nurriberarwl street �N. state. and Z/P code)
Name af assignee w oNer owner w hdder of mortgape
�d�
suee4 �'% �rE
Dces appM-ent ovm propeny m any ame�
munryinlrWiana? ❑ Y¢s
�
.
Deduc9on apWwed'o� ihe amount aF.
r�
Si9ranne U Crnmb nudimr
20
It wrtreC vriM someor�e oNer than spouse.
� u �a2T, Pr�r Rrr,,< �
'\It KL..�
la - ia � �
unPaid as d I U Ne e7�� the sde
legal a equilable oxme(?
❑ Yes ❑ No
Is the MbGenY in QuPStion: Mrn�aOy AssesuE
❑ Real Pmpenv Q MnuaO�i A�ssed
Has Na deduGion been requeste
Fw arrent yeaR ❑ Ye
20
D3te (�mYh, daY. YEa�
m property
❑ No
20
I I We certiFy under the penalry of perjury that Ne above and foregoing informalion is We and cortecl arM that �he applinn[ is a resident of IrWiana ard
owner I contracl buyer of the afoiemerrcioneA property on date appiication is filed. _
Person
authnaed person
state, and LP cotla)
vo.rer ornn�ey a cy
ar+tl ZIP oode)
Date In