HomeMy WebLinkAboutMortgage_D'Amico^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
FOR DEDUCTION FROM ASSESSED VALUATION
�• � State Fortn 43709 (R11 ! 6-09)
S ! P25oibed by Departmenl ot Loml Govemmen� Fvance
�u
lNSTRUCTIONS:
To be filed in person w by maii witA the CounryAUddw or Caunry RecoNer o/ fhe county whe2 fhe property is located.
Filing Dafes: 1 J Real Pmperty: Must fi/e dunng fhe year for which tha deducGon is sought.
2) Mo6Be / Manulactured Hortres rrot assessed as Real Pruperty: Musf file during the fweNe (12) rtanths
before March 31 0/ each year the deduction is sougA[.
See reverse side for add"rtional instnm.Uons arM qualifications.
PKsessed veNe d mal pope
Alarrh 1. artmrt year
�I ro. wfial is Ftis l twr e�
It riartie on remftl a SdfMG
Year
2 �°Q�PYd���
County Recorder
ssmreve� e) ��� GIBSON COUNTY AUDITOR
s,��,�,;,�, _ o o a, o� 8-0 � Y Record numCer Page numEu
- 3- -/oo / a- �-5 / �
Martgage / Contraa iMehteOness unpaid as ot Mortgage / ConvafY inde6tedness unpaid as ol Is Ne applhant Ne sole
March 1, artent year date o/ appG�ation legal w eQUllaNe ame(?
that af aGW��• idirate Debvr.
�ame ot mortsa9ee « cmtrad uner ^
�.N
ACCress of nwnga9ee or anbacl seller (number en
Name al assi�ee w oNer owner or hdder ot nqrig
AdC�j of assignee (number entl str1ee4 �Y. �te,
/� a.i. _r�� .. %S. �. s .
Does E
county
�
cant o+m prop�[y m any o�
�d"ena? V � Yes ❑
appiwud'o� Ihe amount ot
20
�4 ciry, stete, aM Z/P code)
C �e� f'1 T
i
If yes, what counry/.+
COUNTY
20 _ � 20
��O O � � ❑Yes ❑ No
wned WiM 5omeare othar �han spDUSe. iMicate wMh wtwm
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�rature d CoumY AWi �'^b
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I/ We certify under ihe penatty oi perjury that above and foregoing infortnation is We and correct ar�d that the applirant is a resident of IMiana aM
owner I contract buyer of the afwementioned operty on date applicabon is filed.
� ers lW r�am �� Date (nrnth. daY. Y�a�)
II "tle address �o(app��anl (number street. rJty, , antl LP code) / _��
7i7i i �J
u�o(aea oy aWr e:ewcea Pw�er wana„er a M �c ��.�-iz-0.� oate (ma,rn. da�: r�d
Idress of aWiwaed person Inum6e� antl street, ctly, stale, an0 ZIP oode) .