HomeMy WebLinkAboutMortgage_SnipesSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun nshi
_ FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fnm 43709 (R70 Ai-08)
` � Presaibad DY �Mient d Lom1 GovammaM Finanm •
INSTRUCTIONS: �
To be fifed in persm or by mad wifh tlre CouNyAWitol d the caunty whe�e fhe property is bcefed.
Fling Dates: i) Rea/ Property: Musf /de duing the yeer lor which the dedud"mn is sought. /�
2) Mo6de / Manulach�retl Homes not assessed as Real Property: Must fde dunrg the tweNe (12) monlhs 6eI eri�("�Y 3I�aE(r`�r ear
meaeducrionissaugl,t. GIBSON COUNTY UDITOR
See reverse sde tor adddional instruUions end quali6cations
npp&amSownerarmi,iGxtdym-see.emtaionsm.rew�ay�a'de) �., � ' 1
v�: �
n�n i. arrem y� I e�' ��
H ro. what is his / �er eutl share cf i��e5T1
�5
tl �4me on Iemrd's Q�erenl �han Ih� a( aGV�N. inCimte heb.r.
Name d matgagee ar cantran seAer _
Nama d�signae w other wner n holder d moriBa9a
Pdtlrass d aaigree (mimbw and sbeef. dll: sfab, and LP mde)
Doas a70�t wm puPe'IY in arry aher 7 yes. Mc
touMV � IMiare7 .--. .--.
oeeurlion acv�'ee in eie amaun af:
20 U 7 20
P
AuGi1n
I/ We certify untler penalty of per'ryry
owner I mntrad bu r of the aforementia
matu 1 fi� rurtrt� ' _ _
� �v
/ 1
Pe�wn a W�o�¢ed by duly exewtad
AddrassdautMrizedparson (num
- Ui�o -aoa. ��o - ��Y ° aoo 9 �„�,w„s�
cdebtedrres unpaitl as d MMgape / Contrad indabletlness �n�itl as o( Is lhe appGmrit @re sda
r date of appli�ation legal a equhaDle ouneR
❑ Yes ❑ No
I( awneE wrth sa`ceona other Ihan sVOUSe, iriE'xale wtlh wRnn
ro me v�m � a��: a,��ny,u�a
, Q Real Property Q Mnualy Assessed
- - Mobik Hane (IC 61.1-71
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Draiv�t• i1'p... ��%
�af-�,�ro. ,. a 75� �......
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20 20 _ 20 _ ZO _ 20
Caurty Dala (mYh. day Y�1
e abwe and faegoing uifortnatbn is true and cureU antl ihat Ne applicant is a resitlent of Intliana aM
KopeM on tlate application is filed.
ffi�N^.
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