HomeMy WebLinkAboutMortgage_Menke (2)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _'iCoum
FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R71 / 6-09)
, Resrn�ed �y Departmerd of Lxal Gaemme�n Firence
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wsrnucnoNS:
To 6e fded in person w by maii with the County Audi[or or Counry Recwder o( the �unry whera the ploperry is located.
FrFrg Dates: i) Real Property: Must file durirg the year lor which the deduclion is saght
2) Afo6Ae / Manufectured Homes nof assessed as Real Property Must file dunrg Me fweNe (72) months
6efore March 37 of each year the deduclion is sought.
See reverse si0e lor adtlitional instrticteons antl qualrfications.
n�ssea vap,e arreal vopertr am
n�a� 7, qimrt year
If n0. whet is h'a / her etad share of intsrsl?
If nama m remN's OiRe2nl than Nal o/ appl
rw�e of rtnrtga�ea «m�aaa sex,
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�
or contrsn se0rs (nwnber and shae4 �Y.
or ottw owner rn halder
Pddress W assignee (numEer ane atree; ary, sfete.
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Counry Remder
GIBSON COUNTY AUDITOR
Recoid numoer � �/
/a �f�(o
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kgal or epuha6k avrtwYi
❑ Yes ❑ No
mdi�te �itt� wtwm
�S I�C jllOpCf�f N QIItlbCI1: /NfX13%Ii�
�j R� a�o�m ❑ a,�,�nra�ssm
a�on� r� nc s�.
pcey ep�rLL avm V�GenY in any ahei It yes. what countyt I What Ta�dng Dctrirl7 I Hts Nu deCWion Eeen (eGuestr� m p�opaty
��uyu,i�a�a? � ves ❑ No ro.cu�,..+nrma _ � v . -r'--��
couNna,uorroa ,�� jK�I (�°,}i�",, /�� _
OrduCliOn apprwad 61 NB amouM oF. ������� ' 1 ,
(�A�-�' �
2(1 20 20 _ Za
SignaWredCounbAUOitw �nry /XO'O.� " �`+' I
l% �
I I We cerUty under the penalty of perjury that the above and foregoing mtwmation is true an.. ,,.n�ca and that the appli�ant is a residerrt of IMiana and
owner I mntract buyer of the aforementioned property on date appiication is iiled.
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� FW res
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Pelson
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1Wy ex¢qR¢E Pcw¢r d AVDmeY a q' IC 61.1-12-0.7
Oerson (numOe� ard sbeeL �Y, state. en0 LP cntle)
oate (monrn, ear,