HomeMy WebLinkAboutMortgage_Crow� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n 7 i Year
FOR DEDUCTION FROM ASSESSED VALUATION �-
• $tdte Fortn 43709 (R71 / &09)
� y�. PresaibM by OepeRrtierk a( tnd Govemmei4 Fnarrn
, JUL $�iaL��iu
wsrnucnoNS: F� � �:
To be filed in person or 6y mail with the CountyAUdhor or Counry Recwder of the munry where the properry is bcated.
Fil'mg Dates: i) Real Property: Must fite durn�g Ne year lor which the deduction is saghG � S%�ynty Auditw
2) Mo6Ae / Manufacfured Homes not assessed as Real Property: Must Ae diu"v'g Me fweHe (12) months 6 t�//uv
6etae March 37 o/eaM year the deduGion is mqhG GIBSON OU Y AW��d�
See reverse sitle fof eddiL'vnal insfructbns and qualficafions.
Appfaanl(ow�prrmnnartAuye�see I /iYionre l //1Mii
N >
V.Innn�� i
I�i!•.°i
As� vahc � mal aoP�`i m a
Ma�fh 1, anW ym
Y
If ro. what b ttis / trer e�a share ot Nieresi7
It nartp on 2mtl a OMe�ent than Ihai at appl
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Eeln+�
n contraU seder (num6er ard snee; cdY. stam,
Nama N asi�ee n oC�u awner w holtler of nfortgaBe
AdCren o( ass�m (number aM st+eet �Y• �. aM LP tode)
p�pey epplirant wm MoV�Y in anY othc If yes. what
�� � ��? ❑ Yes ❑ No
az
GOUNTVAUDROR
numOC Page num0ef
�/ U 333 .-
zs d� me eoa�t um sc
Yes LI No
zneare otl�at IAan spause. uwbicate with w�om
Is Ihe property in Qurstion: M�waDy AssessM
'`_ ��Y ❑� �,
G'E� _ _ .
J!.!1!� e,fU��
�O/G-.�33
3
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❑ No
2p_ 20_ 2Q_ 20_ 20_ 2q_ 20_
Sigrenae N Camty Auditor CoumY Date (mond�. day, �a�
� I/ We cerOfy uMu Ne penatty oi perjury Nat rtie above aM faregoing mfomwtion is true aM wrteU arid that Me applirent is a residerrt of Iridiana arW
owner I mntract buyer of Ne aforemerrtioned property on date apPlication is filed.
ci,.,.�xxu. r��.< ns.m.m� Date (+nonfh. OeY Y��
eANe� of appfra�nnt (num6er aM stree4 �; ��. � LPIo1ode)
p�i 7 —i'� -� 1�.�a� Li TC-G-
utlro�aeA Dy OWy e:eated Power W or Cy IC 61.1-72-0.7
of aW�a'vntl Og� (num6e/md sbeeL �Y. sfate. and Z!P wtle)
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