HomeMy WebLinkAboutMortgage_Keil (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�__ FOR DEDUCTION FROM ASSESSED VALUATION A/
State Fortn 43709 (R11 / 609) . if ,�. ��
�,,,. � Presaioed M�m af Lora� Go.enunent Firence �
Fl Mark [� ;i
wsrRUCnoNS: 8•-•�
To be filed in person w by mai/ wifh the CounryAudiror or Counry Recader o� the counry where the properry is located. F� ���
Fil'mg Dates: 7) Real Property: Must file during Ne }rear fir which the detluction is sought. N U V �� nry AudiWr
2) Mobde / Manulactured Homes rat assessed es Real PropeRy. Must fiIe dunng the hveHe (12) rtanNs
belae March 31 of each year the deduction is spqht. ��y/ ❑ Counry Recorder
See /everse sidB for itional In end Qualifica ' � /� "� 4 �. !�
�a1°"��O1H1BfOr °" GIBSON COUN7Y AUDIZOF
�d Key num0er al d Recofd O Pape yunpRy� �
�°"�-ly",3a a�-tz��s-a�� ���:
af � papMy as d MoRgage / Contra �ss unp�aid ejs �d Morigage / ContrarS uWehtedness unpaN as ot Is ihe appfxant Na sda
Mamh 1. a�ma year Marti� 1. arteM � O`l l J date ot aPP��� �� MNm� �
❑ Yes ❑ NO
tt m. what 6 his / hu esaa shara ot intuest7 H ownm wiN sorr�eone atlrer Ihan sDw+�, mdKate wiM wlwm
If r�artre m reard'a CAtaent than tlut W aDO�t Gtl'ram hebwc Is Me ProOenY in Quation: MnueM Assested
❑ Real ProPenY ❑ ��Y �
Name of rtartpapee a mntrarl setler J ^
{1 . �
J
Addres N nnr[qagce w mntrad se0er (nunbrierd sbeeL �: sfa�M�
Nameofassi�eeermnr......e•....-�.___._�—_ ' - -
naa� a� lS E�n' fil�%l�}d,U f/ 7
���
� �;; �� ,�"a 9
�aio �
�,� «„�,�,,,
❑�� ❑No
COUNTYAUDROR
DeducCOn approved in tlre amount oF.
20 _ 20 _ 20 _ 20 20 _ 20 _ 20 _
SigreWre o( Ca�mb Audkor Counly Dale (/roW1. daY Y��)
I I We certify under ihe penalry of perjury that the above aM foregoing intormalion is We and cortect and that Ne applipnt is a resident of Indiana and
rnmer I mntract buyer of the a(wemendoned property on date appliration is filed.
I- ��?�G% Gi �' ��'1 � oate (mmm, aar. r�+)
Fuo msicent mamz%r apprranc (numae� ana steec �71: sraM, and zra ome)
� I � i S L— �l 50 5. u u�. si�� Z A.� , L/ 7�• s
Pelsan auNw'¢ed Oy duy ezecvted Power a(Atmrney w by IC 61.1-12-0.7 Date (monfh. daY. Y��
Pddmss af aWmf'ved p�sm (number aM street �Y. sUte. an0 LP cotle) .