HomeMy WebLinkAboutMortgage_Cowling"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R77 / 609)
S r Prewibed by DepartmeM o1 Ldal Govemrtrent Fnance '�
File Mark
wsraucnorus:
To be filed in person a by mail with the CounryAud'ROr or Counry Recnrder o� the county where the property is located.
F 009
Fi(ing Dates: i) Real Property: Must file dunng the }rear (or whicA the tleduction is sought. � Counry AuEitor
2) Mo6de / Manufadured Homes not assessed as Real PropeRy: Must file dunng Me lweNe (12) monMs
6efora MarcA 37 of each year the deduction is sought. � e�
See reverse side for additional instructions and qualifications. G IBSON COUNT
npprram(owne.y, oonaaubuyu-seerestnt��onsm rses'de)
l" er, , � . ' .. r. .�� � �.. �. , _� L—.
veGC � real p�opttty az d
. ar�ent year
II no, what is his ! her exact shara of inte�
It name On RCWd is dfierent �han Mai oi
r�a� m ��q� o �v� �uer
.
Add2a W�ee ar ntrari seDer (
Name M assignee w othu ownet w hdd
r\1' kgal desmption R¢croid number Page num0er
- lq - Oq -t l
Mor(page / ContraG inde6tetlness unpaitl as W MMgage / CrntrarY uiCeMeCrress unG� as d Is the aPP�^t Me sole
Mard� 7. artent yeer dare of aDP��� legal or epuitahie ovmM
� es ❑ No
If wmed vriM somaone other ihan spouse, trdimte with whom
in0icate Debw
cdy, smm.
(numDer aM stree4 �1: s+ate, and ZIP ootle)
�oes a�i�nt own yoperty in any oNer
counry in Intlana? ❑ Yes
D�uction app�oved in Ihe amount ot
20 20 _
SignaMa W Coun�YAUtlitor
1/We
I( yes. whet muniyl
cou
2(7 2�
i ��
Asse55ed
� �onte IC61.
Di•a�vcr NO... a�......... —s—
Card NO. .. �.J�...�.�.........
(15;000.v�
1Miat Ta�drq Distri[17
�
� Hz- c detl�m Deen reQu
r�or c �rt yeaYl Ye
L
6 (�IL
� -\
Dete (��. �Y. Y��1
on propeny
20
urWer Ne penalry ot perjury that Ne above a� foregoing intortnation is We and correa ard Nat the applicant is a resident of Indiana arW
act buyer ot the aforemerrtioned pm rty on dat applicatlon is filed.
S fiN name) / Date (nwntli. daY. Y�A
�vM� �s /J7i / � 1 7 —.'�h � 7t�I'
orOylC
Add2ss of a Wrorved person (numbe� an0 stree; ci(y, sfate,
Date (monN. AaY Y�)