HomeMy WebLinkAboutMortgage_Haley (2)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fortn 43709 (R71 / 609)
,' ,.,, Piesnihed by DePartmarit o( Laal Govemment Firence
wsrRUCnoNS:
To be fiied in person w by mad with the CounryAUditw or Counry Recorder o( the counry whele the property is located.
Fil'ng Dates: i) Real Property: Must file durirg Ihe year for which the detluction is sought
2J Mo6Re /Manu/auured Hanes not assessed as Real PiopeRy: Must file dunng the fwelve (12J months
before Ma�ch 37 of each year the deduction is saght.
See reverse side for adtlifionel insWCtbns and qualificafions.
Ed rdue af mal
1, artvC yeer
�
O( V11PlB5l?
�
File
��Q�yAUditor
Counry Recorder
GIBSON COUNTY AUDITOR
striPtio/n�� /'� 4 Remrd numbrs P e number
� �W � l U
/ Contraa 4Mebtetlness unpaid az of Mortgage I ContrecY intlehtedrress unpalE as ot Is Ne epd�� �e sok
�jrtent tlata of appliqtion Iegal a eQUitaWe wmM
�( O ❑ Yes ❑ No
rc aw,ea wim wn,eone ahar Ihan spouse. 4di�te with whom
�Q�OM'. j$ jhQ �p�pfly 1I1 QIICSbIXI: i1f111U8�`/ ASSC552�
❑ Real Roperty Q Armuaily Assesu.d
a+o��e r+ome nc ��.�-�
Name of matgagea v mntrad seDer L� ,/�
1J
ACdrea of mwtgagce or contract se0er (number and sveeL �y. sb�. en7 LP code)
Name of asvryiee or oNU owner w holder of mortgage
rna�es m ass�ea lnumcer am saee� wY. sem.
Dces ePWinnt axn property in any aher
murtly in Ind'gne?
❑ Yes ❑ No
DeEUCGOn approvad in tlre amount oE
�, DCa\1'Ei' \�..,,o�„�,lQ.........
�
C31"Ci �o���� ..
i .........
_ �W
fetlufYim Oeen requested m P��Y
n Year' r� .. r�
20 20 20 20 20 20 20
Sigrenne o( Camb.4udimr Caunry Date (rtonth. daY. Y�A
I I We certify under the penalry of peryury that the above and foregoing intortnalion is We and mrtecl and iha[ ihe applitant is a 25ident o( Indiana arW
� owner 1 contracl 6uyer of the aforementioned property on date aDPlication is filed. �
dry, state.
Pefson auNOrrsetl Dy Auty esecutetl Power of A�Imfey ot W G 61.1-t1-0. /
V
MCrass of euCror'ved Ge� (numbar arrd street u7: sfate. end LP code)
(month. daY.