HomeMy WebLinkAboutMortgage_Bittner (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
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� FOR DEDUCTION FROM ASSESSED VALUATION
� • State Fwm 43709 (R71 / 6-09)
�' � Presaibe0 by Depanmenl of lual Govemrtrenl Frerxe
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wsrRUCnoNS:
To 6e filed in person w by mail wifh the CountyAuditor or Counry Recorder o! the county where the property is located.
Filing Dates: 1) Real Pmperty Must �te during the year (or which the deduction is sought.
2J Mo6de /Manufactured Homes not assessed as Real Property Must file dunng the M1veHe (12) rtwnths
6ePore March 31 oleach yearthe deduction is sought.
See reverse side for additional instrucGOns aiM quali�catrons.
A�nt(ownerarcontraflbuyer-se@�restn'rdonsonreoersesiiel. � _
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of
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1( no, whal is ha I Mr e�cl share of interesi?
11 name m remftl is Ntferenl ihan ihat ot dppfrant triEi`aoe
Nam¢ Of mort9a9eB b cMtratY seller ��l
Mdress W�romJa9ee w contract seAer (numher ard stree4 �: stefi. aM ZIP cade)
Name of assignee or oNer owner or hdder of mMga9e
AdCress ot assignce (num6er ared street �y, slate. aM ZIP ootle)
Oces eppircant own property in any otlrer If yes. what countyl
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�n�itor
County Remrdu
GIBSON COUNTY AUDITOR
Retord numbel Page numCu
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o� PP��b^ intlebteMess unpaid as of �I o�eWitable ownrY�
❑ Yes ❑ NO
i someone aher Ihan spouse� iMiwte wiTh wham
Is tlre PbPe�Y in qunstion: MnuaOy Assessed
�a1HnPertY ❑ArmualhlPsse°..,_sed_.._
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Sig�ahae W Camb Aueitw Caunry Date (monlA. daY N��
I/ We certify undes �he penalty of perjury ttiat Ne above anC foregoing infwmalion is We and cortecc arW iha[ the applipnt is a resident of indiana and
ovmer / contraq buyer of ihe afo2mentioned property on date application is filed.
SianaWre (owne/s!W reme) . - n _ , /' / . Date (morN�. daY. Yaei) _ _ . .
crry, slate, antl
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aurtroiaetl by duly exeated Powa of AttaneY or Cy IC 61.1-12�.7 I�� (�N, �r. r��
: of author¢etl perso� (number ard street cdy, state, aM ZlP code) .