HomeMy WebLinkAboutMortgage_Seibert (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
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; FOR DEDUCTION FROM ASSESSED VALUATION
Sfdte Fortn 43709 (R71 / 6W)
S � Prgaibed by Departmenl of Lacal Govemrtrent Fu�ance ,
�VSTRUCTIONS: J
Fo
�O be filed in person w by mail with the CountyAuditor or Counry Recorder o! the counry where !he p�operty is located.
Fi7irg Dates: 7) Real Pmperty: Must file durirg the year for which fhe deducfion is mughL � N
2) Mobde /ManuFactured Homes rrot assessed as Real Property Must h7e dunng fhe hveNe (12J rtwnths
6etore March 37 of eacA year the deduclion is sought C�
See reverse side foraddifional inshuctions and ou "mations.
b
�¢@[y Auditw
Caunry Recorder
AppGrant(owneror vyEr-see on sde� GIBSON COUNTY
���G- � - -� - • - �-- s
ea vdue a r� poperOj as
7. narent year
If no, wha� ¢ his / her ezaU sliare
�er / legal desaipUon Recon
-�3-b�-4bb-DOa, a3a-oay
MoRgage / Contraa intle6tedness unpaitl as of Mortgage / Contract intlebteEness unpaitl
MarM 1, wrtent yeer date of application
If riame m rernrd is tliRerent Nan ihat of appG�an; iMinte bebw.
Name oi mortgagce or mntrad seller
Address of mortgagee or mnbact seller
Name of assianee ar other owner or hd
stree4 �: s+ate.
nartgage
ACCress of assignee (numbei and sfroet, ttiy. s7afe, end ZIP oode)
Ooes applitant own yoperty in any oi
counry in InEana?
❑ Yes
amount
PD]
SignaW2 N CamN Audita
20 _
D1'fl11'CI' 1�'�....,":.Y11 ........
•t
C:11'C� 1�'�. ....,` �Q � �
....
�J�ll�.�..........
Is Me appfrant ihe sole
1eg31 w elryitade OwneN
❑ Yes ❑ NO
someone atl�er Ihan spouse. indimte with whom
Is the P�7ertY in Question: Mnualy Assessetl
❑ Rea� aioaero ❑ /����N�
i Nas Ihis deduGbn Deen requested on proprny
j . fw arrent yeaf.� ❑ Yes ❑ No
'— � Zp— � 2(1—
oac� b�m. eay. rea.J
I/ We certify under the penalry of perjury that the above and (oregoing infortnation is true and cortect and ihat the applinnt is a resident of IMlare and
owner / mnVacl buyer of the �orementloned property on date appiin0on is filed.
�naN2 (owne/s hN qeme) ��.— Da1e (monN, daY Yaah
appfipnt (number antl sbee( tlry, state, arM
,. C(7 S l/� 1-� � �..
PCdress o! aNhoraetl person (num0er and stree4 ary, sfafe. and LPCOde)
�� �N . `I %6 3