HomeMy WebLinkAboutMortgage_Harpenau (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi
_ : FOR DEDUCTION FROM ASSESSED VALUATION
.• State Form 43709 (R77 / 6-09)
S / Presrn'Eetl by DeP���rtl of Laral Gavemment Frunce _
File Mark
INS7RUCTIONS:
To 6e filed in person or 6y maii wi�h Ne Co�ntyAuditor w County Recorder of the county where the property is located. �
Fitirg Dates: 1 J Real Pmperty: Must fife during the }rear tor which fhe deductlon is sought.
2) Mo6�7e /Manulactured Homes not assessed as Real Prz�perty Must file dunng the twelve (12) months — /��
6efore MarCh 31 of each year the deduction is sou�ht. ��`^'
SeereversesideforadditmnalinstnxGOnsandqual�cations. GIBSON COUNTY
Apq'�n� (ownerar cqytrqct buyer ; see resvirlians m rel'�rse.4�de) . �
- - ac - vu - � a. o
of real property az oi Mortqage / Coniraq indebteEness unpaid as
year Marrh 7,�rtent year
m
Name of rtnrtgagee or contrarl se0er
AEtlrea of �T� w mntrad snAer (num6ar and stree; crty, state.
Nama of azsignee w oNer owner or hdOer of mortgage
Auditor
Recwder
I legal a ewiiaEle ame/?
❑ Yes ❑ No
sva+se. ifWkate with whom
Is Ihe P�nY in QuesDOn: MnuaM Assesse0
❑ Real RoPenY ❑ !?n��a��Y Psses�d . . _
Atltlress 01 assynee (numGBr eM shee( C4y, SIBte, aM LY mtlB) .
Dces applimnt o.m pmperty in any oMer ...• _ � Has Nis deduGion been requestetl on p(operty
munry in Ind"ana? ❑ No ior a(rent yea/t
❑ Yes ......... ❑ Yes ❑ No
D1'a\\'�'C 10. .
DeEUCdrn approved in Ihe amount aE 't'{ � � , , , , .
zo
I/We
C11•� \ . ......
..........
20— �asS,ocA `P�' 20— 20—
���� 513 e�� �� ��. �,;,�o
unAer Ne penalry of perjury that ihe above and foregoing informalion is true and cortect a`M Nat the applinn[ is a resident of Irdiana ard
acl buyer of Ne aforementioned property on date appliption is fiied. '� �'
s fidl nsme) . n !� � .• t •• Date (monN. daY. Y��)
�
L
iumoirsea oy dwy esecuA9 aower of nn«ney « oy IC.6
of aWiortre0 person (numDer aiM sbeet, ciry, state, aM