HomeMy WebLinkAboutMortgage_Mosby"'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
n State Fortn 43709 (R77 / 6-09)
�' � Prevsibed by Departnient of Laal Govemment Fnance
1
wsrRUCnoNS: F«,�m�a
To 6e filed in person o� 6y mail with the CounryAudRw or Counry Recorder of the county where the property is located.
Fil'mg Dates: i) Real Property: Must file durirg the }rear (or which the deducfion is soughf. S E P � nry Auditor
2) Mo6i1e /Manufactured Homes not assessed as Real Property Must hle dunng [he twefve (72J months
6efore March 37 of each year ihe deduction is soughL ❑ County Recorder
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See reverse side for adtlitional instrucGOns and qualifications. . �' ( u jJ '
IAppGcant(o»��coritr6Ft�uy�-�restrirf.ons�r1elverseslde)ln _ _ /I . A1 /1 �. � GIBSON COUNTY A
rdue d real poperty az d
If ro, what a h's ! her exad share of interest?
If name m remrd is
orcontract
�a3-k�4cb-c�Cil. �o9-oa ����� �ay3,S�i7
�/Contrac[ iMebteCness unpaid as of Mortgage / Contrari indeMetlness unpaid as M Is ihe appli�ant Ne sole
Id��� ^ Y� date af aPPGntion �a' � Yese ❑ No
M Vv
If owned vrith wmeone other Ihan spouse, indicate vriN whom
Add'ess U mort9a9ce or mntrw se�er (number aM streeG �:
Name of assignee or oMer owner w MN� af mortgage
�tlres ' —
�E Dra���er NO....°o.���......... m
�'�' - 35 i fi
— c:��-a �o . ............
�3��0 �� �o�
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2� � �� � p — za
I I We certity-unc
owner I contract
Wha� Ta�drg
�
Is ihe P�PenY in O�o^: �nuaM fvssessed
❑ Real Property ❑ MnualyAssessed
�udion Oeen reQUested on pmprJty
�n ❑ Yes ❑ No
zo _ i Zo
Caunry Date (nwnlh,
—C�3—�X
of perjury a the above and foregoing infortnalion is We and cortec[ and that the applinnt is a resident of Indiana and
oremerrtion roperty on date appiicalion is filed.
Date (month• day, yearJ
�'C�CI Q_ — 04.03.09
FJII resident add�css of ap�nnt (number aM street, �j
F� Ia��9 S. 35o E. �ia
Person author¢ed by duly exewted Power of Auomey w
person (number arM sbeef, dry, state, an0 Z!P code)
p�or,u�, nar. rea�