HomeMy WebLinkAboutMortgage_Maierry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
. . �• State Fortn 43709 (R11 / 609)
�,�„ j P�esaibed by DeP��N of Loal Govemmenl Firence
ie
�NSrRUCnorus: ,,�y,�Lpdq�j
To be filed in person w by mail with Ihe Co�ntyAuditw or Counry Recorder o� the county where the pioperty is located. F�Z7' Y fi 1� ZQ �Z
Fif"mg Dates: 1) Real Pmperty: Must file dunm� fhe yearlor which the deducfion is sought. � Counry Auditor
2J Mo6ile /Manufadured Homes rwt assessed as Real Property Must file dunng the nvelve (12) rtwnfhs C.�v��e� d�
before March 310l eacA year the deduction is sought.
See reverse side for additional instructions aiM qualifications. GIBSON Cn� i ur� ... _._ _
Yrrvl RoP�Y az d
�
ro. Wh'dI 6 h15 / 11C! CI3CS ShNE 01 Y1�Pl¢SI?
It name on remfd
of morcgagee a rmttari
legal EeSGiption
�� �_ o_ ooa, sao - o a
xtgage/ Contract irdebtedness unpaitl as d Mongage / Cmtrac
ard� 1, q�rr¢n( year date of application,
mdkal¢ bebw.
other owner w holder ot rtangage
AOCress o1 assig�e (numDer aM stree4 �Y. sfate,
Dces epditant own pfoperty in anY olher
counry in Ind'ena? ❑ Ye5 ❑ No
approved'u� ihe amouni of.
ovrtred �vi� mmeone
� / �3� 3
id as of is Ihe apd�^i Ne sde
OG �ega�«eWitadernmert
❑ Yes ❑ No
spoum, ifdicate wiM xiwm
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state, and ZIP code)
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�f,�,,�,a�m��n
zo_ i �— i p—
MWifor
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)UNTYAUDROR
20
Caunry
I I We certi(y undu the penalry o( perjury that the above aM foregoing iMOrtnation is We ai
owner I conVad buyer of the aforementioned property on date appiiptlon is filed.
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FWI rrsi eni adAmss W appfic�a�l
� C��a w. ia
Pe15pn auttror¢ed by Euly execul
Ey IC 61.1-12-0]
person (numbereM sbee; ciry, state,
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C.u,
� �011-53�a
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