HomeMy WebLinkAboutMortgage_Birchler"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ .; FOR DEDUCTION FROM ASSESSED VALUA�� ��
State Fartn 43709 (Rtt / 6-09) r'1
�,�,. � PrPSaibetl by OePartnienl W Lncal Govemmenl flrerce 1
File Mark
wsrRUCnoNS: SEP 19 2011
Fortn A�:
To 6e filed in person w 6y mail wdh the County Auditor or Counry Recorder o! fhe counry whe2 the pmperty is located.
Fifing Dates: 1) Real Properry: Must file during the year for which the deductron is�ht, Counry Auditor
2) Mo6de / Manufactured Homes rat assessed as Real Property Musf (i7e aunng t e (12) months
6efae March 31 ofeach year fhe deduction is soughG ❑ Counry Recorder
SeemversesrcieloraddiUOnalinstructionsandqual�catrons. GIBSONCOUNTYAUDITOR
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1. arren[ year
�Mat b Itis / irer e� share of interest?
on remrd'a dMUUit Ihan that d app6cant, m0ifate Debw:
nnrtgagee or contau
nddren w rtartgagee or cono-aa sener (nuneer end saeet uN,
Name ol assignee w other owner or holder of nKrtgape
AOCress ot assignee (number aM stree; rdy, state, end Z/P code)
Mhe1
- �-/3��c�+��2
J C��-�y
� �o'uf�s E �
_ avli-a�s�
� .3S- / 0� -m
e6tedness unpaid az of Ma
�-y-�d �� Eau
lJt �
If axnad wiN
I Recaftl num
0 9/-0�
�e I Contract i�Webtednrs unPaid as of
appGUtion
�eorre other than spouse. "uMicate with �
Whal ia�dtg D51riC?
COUNTYAUDROR
zo zo
�I Page nyq�ber�
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Is Ne appGcanl ihe sale
legal p epuita6le ovmeR
n Yes n No
IS IM PIOpCII)' T CIIGSOOII: MIW2AYASSfSSL�
❑ Real PmP�Y ❑ H^^��N �
Mobile Fi�ne fIC 61.
Has Ua deduUan Deen repuesteA m P�Y
fwartemY�n r-� _' r-�
�
Date (monN, tlay, yee�
zo
I/ We certify under the penalry of perjury that Ne above and (oregoing infortnaGon is true end cortect and Ma[ ihe applicant is a resident of IrMiana and
owner % mntract buyer ot the aforememimed property on date appiication is filed.
�anue (owneYs MI rert� ` n Date (nnnUi. daY. YHaA
E�l addre�cbl a � S�rard stree4 �; ; re.�f� �e,
tT�i C � 1
/ O J 7
auNaaed by dWy esecuted Pawer a(Attort�ey a by IC 61.1-12�.7
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Date (rtpnN, tlay,
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