HomeMy WebLinkAboutMortgage_Gray"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS un Township Year
; FOR DEDUCTION FROM ASSESSED VALUATION Z��2
:r=— 5
Sfate Fortn 43709 (R77 / 6-09) MA
��«. ° Presaibed Dy DepaNneM of Laal GovemrtreM Firence -
C '�.MFile�Matti
�NSTRUCTIONS:
FO""�� ITOR
ro be filed in person w by mail wifh the CounryAUd��ar fir whichRthe deducfion is sough�e� �e ��m �� IBSON OUNTY �un AuCitor
Filirg Dates: 1 J Real Pmperty: Must fde dufiig Ne
2) Mo6ile / Manufactured Homes rat assessed as Real Property Must file dunng [he twelve (f 2) months ry
be7ore Maich 37 0! each year Ne deduclion is sougAt Counry Recorder
See reverse side for additional instruclions and qualifications.
AppGrant r a a 6uyer - strraons m rayapre sitle)
� ��
wg Dis Key nmber / legal desaiD4 Rewrtl numbn Page num0a
-z -�b-�a� cn .oi -oa
vWue cf real poP�Y as of MMgage / Canuaa'udebted�ss unPaid as d AAortgage I Convatl'videMeMess �mV� as of Is the ePP�rt� tlre sde
1, wrent yrar Ma�U 1, wrtent yeer date Of aOP��� kga� M equitade amM
�,��%l%� nY� nNo
If no. what is �5
It name m eemftl is Cillemn[ Nan Nai at appGCant uMibte bebw
Name af mortgagee or contract seAer C, J a
�.�/�
Address of mortgagce w contraa seller (numbai
owner or ndaer ot mortgage
sYdte.
naaress ot as9gnee (numner ano suee; ary, srare, aro ur caoe)
Does appFmnl w.n property in anY �er If yes, whal munry?
munry in IrWia�? �.. �_.
somearre
Is Cc MoGenY in Guestian: Mmielty Assessetl
❑ rxe� a�oaertv ❑ a�r,uaiy a�sessed
nw�e reome nc s
— Dra�ti•er NO..c�01a
Card i\��. ....!'S�
.. .............
" 5 3 �f', , � 15�, '7UD. �
20 I 20 1 2o I 20 I zo I zo I zo
�nY
I/ We ceRrfy under Ne penalry of perjury Mat the above and toregoing infortnalion is true and cortea arW Ihat the applinnt is a resident of Indiana aM
oxmer I contracY buyer of Ne ataementioned property on date applicabon is filed.
7natum�(awne/s /W rema) , /'� /j. Date (moruh. daY. Y�a�
a�so�
IC G7.
autt+w¢ed person (numDer amd StrHeG ary. State.
oa� c�n,, aar.,ean