HomeMy WebLinkAboutMortgage_Johnson (12)"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
:, —.
: FOR DEDUCTION FROM ASSESSED VALUATION
• Sfffie Fortn 43709 (R11/6-09) � � �
S P P�yyp p�, pe�N�M of Lacal Govemme� France
"" File Mark
STRUCTIONS: F� �� �:
To be ned in person or by mail with the Counry Audifor or Counry Remrder o/ fhe county wheie fhe�p(q�e �s Io�t�
Filirg Dates: i) Real Property: Must �le during the year for which the deducfion is soughL H U U� LU I L j�'� Counry Auditw
2) Mobde / Manufactured Homes not assessed as Real Property Must file dunng the M1velve (72) months :K
6efo�e March 37 of each year Ne deduction is sought. C.�. f+b:%�..� LI �unry Recorder
l\
See reverse side (w�lditional instructions and qualficatrons. V C
qppfaant(owne�or uxer-�eerestric�msmr�versas:i � n ^ GIBSON COUNTY AUDITOR I
p�opaty a d
Key rwmb fr / legal description //
c'�l�-1 :3a -lo�-boo.7/S-o
Abrtgage / ContraU'udebtedness unpaiA as o( Ma
Maich t. artem year r,., �� tlau
no, wha� is his I Mr e�mU sl�are ot interest7
rwne on record 5 Q�tFerent Ihan Nat of aPP�
Name of rtrortgagee or
bebw
Address of morlgaqee or contraU srder (numher and sheeC �y. sfa.e. aM
_ ��_ _ _
Name t\ N� SuN, �l�'(�13 % D/'7/�( �
— JV
oaa
20 _
Sig�atlne
�a �aso
20 — � 20
I I We certify under ihe penalty of perjury tFiyl Ne above arW fc
owner I mntracl buyer of Ihe a(orementioned property on date
a„an,�e ro,+�s rw �>
resitlenl
by Outy executetl
��I"�st'Z'.t
tlry, sfate,
by IC Fi7.1-12-07
arM sheet dry. slafe, an0
ConVari'vitlebteMess unPaiO as d I Ls�Ne
fi�atmn
If awned wiN someone other Cun spouse. indra[e
Iwnai r�ry oamaa
�uNrr nuorrort
20 _ 20 _
Caunry
P�3asa
Yes L� No
Is the P�PQnY in QuPStion: Mnua�y Assessed
�] Real PrnPertY ❑ �^^!!�Y �
� N� �a�, e�� �a���a �, ��v
rw a�,en� y�r n v� ❑ No
zo_ � zo_
yea�
intamalion is true an0 cortect and Nat Me applirant is a resident of Indiana aM
ion is filed.
Date (nmvYh. daY. Y��)
Dace imonlh. CaY,