HomeMy WebLinkAboutMortgage_Sollman^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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� FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R1116-09)
�` 1 pr¢wlp¢tl by �eparimenl of Local Govemment Frunce
"" File Mark
INSTRUCTfONS:
To be filed in person w by mail wifh the County Auditor or Counry Recorder o� the wunry where the p�operty is located.
Fi7irg Dafes: 7J Real Pmperty: Must file during the year for which fhe deduction is soughf. .. � �ouaty qudimr
2) Mobi7e /Manufactured Nomes not assessed as Real Property Must file d�nng [he lweNe (12) months �
before March 31 of each year the deducfion is soughG C�n ecorder
Seereversesideforadditionalinstructionsandquali�cations. GIBS COUNTYAUDITOR
e,.,,F,-�.n t..,.,.wr.�.mmrarl buuc� - see res72Ga¢ on rBVarse Si1e1 .
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p'opertY as W
M�mber / legal tlesaipUrn �
-a _o - DD -DO
A1p��pyp¢ / Cantract irdebtedness unpa
Marrh i. wrceirt year
ofinterest?
►ame of mwtc�agee or contract se�ier �/�
�
Address of matga9ee w contraG sWer (num6er end streeG cdy, sfate, and
Name of assi9nee w otlrer awner w halder of rtprtgage
(number and stree4 �Y. state.
w —� �—
property in any oNer If yes. what countyl
❑ Yes ❑ No
DeduGion appfwed'e� ihe amount oF.
20 _ 20 _
$igruture fCounryAuditor
• T Yw�
I/ We certify under ihe penalry o r7ury Nat
owner I conVad buyer of the aforemenlioned
� ,,,v'y�-t �.. ' ; "
/i�%
Fu0 resident adtlress of
ii l/Soo S,
Pelson auihor�d Dy Ci
r:a.�•„
�
awned vriM somearie oiher
Page number
s �mpaid as d Is Ihe appfmanl Ne sae
legal w eQudable mmeR
O ❑ Yes ❑ No
iMifate wilh wtnm
Is ihe rty in Ques6on: Mnually Assessed
eal PtoPeAY ❑ Afmually PSSeSSed
Mohle Hmie OC 6
What Taring Dis ' -
D���„���-.70.. aO1�:.�....
1.
COUNTYAUDROR
Card NO. ..�...9�.. .......
5,�9_ co. � 9� $Cn. °=
2O 2O N _ _ _
Couny Dam (rt�r�f14 tlaY• Y��)
he ve arW foregoing infortnalion is We and mrrecl arM ihat the applicant �s a resident of Indiana ard
�ro rty on date appliwlion is filed. '
Date (mwitli. daY• Yaa�
imbSf' an0 sfrec4 dry, slate, apdt P
f/4„bst4d
power of AtlumeY w by IC 61.1-t2-
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