HomeMy WebLinkAboutMortgage_Southwood"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear �
_ FOR DEDUCTION FROM ASSESSED VALUATION ,
Siate Fortn 43709 (R71 / 6-09)
,a / Presoibetl by Deparvncrd of Laal Ga+emmerit Fu�ence
F Ma
wsrnucnoNS:
To be frled in person or by mail wiN the CounryAUditor or Counry Recorder o! tAe county where the property is located. �
Fiting Dates: 1) Real Property: Must file dunrg fhe yearlor whirh the deduction is soughL Coy' �{yquditnr
2J Mo6Ae / Manufactured Homes not essesced as Real Pmperty Must file dunrg tAe tweHe (12J months CC LU1 I
before Marth 31 of each year the deduction is sotyht r C Counry Recorder
See revers - e 7or additional inshuctions and quali(�ations. •�
Appfimnt (o ormitrarY buye - see ieve side) .
GIBSON COUNTY AUDITOR
T�'^B � _. .. �Y ��9� dew�fion Recortl num0er P e numher
a -oa4
Mortp a,ge / Contraa NOebtednnss unpaid ac d Mwtgage / Contrart uiCeh�s �m7eitl as o! Is Ihe eG�� e mle
Ma� 1, anmsl yevfr Eate of aPPOptun kgal a eWifable amM
❑ Yes ❑ No
It m. wlut s na / ner eYar] snara of Infemst? tl awrred wiN someom Wrer �han sPO�. md�te wmh whom
tt rartre m �emtl b Qrtlerent lhan Nat d aPWm�4 c�tlkate Debw. � is ihe MoPertY in question: M�uaDY A,sessed
❑ Real Roperry ❑ Nmually AsseSSed
Mobile Flane QC 61.1-i
Name of rtiortgagce ar wnuact seAer n
��.D�•
Addrea of mo�agee ar mntraG se�er �nfmOer eM shee; cdy, srata, aM LP cade)
Name at assignee w other awner ar holder af morigage _
AACress of assignee (number aM svee4 �}: s+ete, end i
Dces appikarLL own P�oPertY in any oNer If r ......... ��eduCim Eeen requesteE m P�Y
counry in �n0ianap ❑ Yes D C.`1\V C I' � 0••••••• 1• y�p
❑ No , . ` `� ❑ Yes ❑ No
� ........
Card NO. .....; . � ....
Deduction appmved'u� tlre amount oE � I 1\^
�.+ � � �
zo_ zo_ m_ zo_ zo_ zo_ zo_
sly�ave or CrnmN nwitcr ca,nry oace (rtbrtlh, ear. r��
1/ We certy under Ne penalry ot perjury that the above arM toregoing infortnation is we and correct arW that Me applicant is a resident of Indiana aM
own � n yer merrtroned P�PenY on date aPPiication is filed.
�o�� ,�, ���a _aey ��
' ent aGd of appGranl (numDe� and streat d1y, sb1e, end ZIP catle) "/
39 S. ws�:.rrfowth ot�.�•-•-r {�s.��'qh'+c�i� 2N �7G3`/
, autMriad by duy rxecuted FMer W ARUneY a M IC 61.1-12-0.7 Date (maifh. Ea}; —�
Address of auCmr¢ed persm (num0er aM street dry. sb(e. antl ZIP code) .