HomeMy WebLinkAboutMortgage_Staples.• °•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
- FOR DEDUCTION FROM ASSESSED VALUATION
S�ale Fortn 43709 (R8 / 2-07)
�' ,s�. � Presmbed by Departmenl of Local Govemment Finance
F' e a
INSTRUCTIONS:
To be filed in person or by mad with the CourrtyAuditor oJ the county where ffie pioperty is bcated. z
Fding Dates: 7) Real Property: Dunng the 12 months before June 11 of the year tfre deduc6on is to be elfec6ve. � 1 � � �� Z��f �
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 2 0( the year the deduction i Mle e ecLve.
See reverse side fa addifi�nal insfnections arrd qualifications.
I Appl' M er ar mNrad Wryer - see resLecfian m reverse sjde)
� ��� GIBSON COUN7Y AUDITOR
I Ta DisUid Key number / legal desuiplion Remrd number Page number
aG -d3 - i6 - s�oo _ o. o_� a� v o a 3Y Y a-
value of real papaiy as d March 1. anenl y�r Mwigage � Cuniracl indebtedness unpaid as of March 1, Is �he appGpnt Ihe sole legal w eQuitade owneR
aR�,� ai�' ��o
❑Yes ❑No
If
Name
is his I her ezact slare at
m record is d'Aferent Ihan
Address of moM1gagee w mnVact saller (number aiM streel, oty, sfale.
Name of assig�e or otha owner or hdder of matgage
Address of asvgnee (num6ei arid sVeel dty. 9ate, and ZIP code)
Dces appicanl own property in any other If yes, what
couMy in Indana9
❑Yes ❑ No
Deduction appioved in the amoun�
20 arl 20
v
Sigriawre ot Counry Auaitor
If wmeC wiU� someane olher lhan spouse.
Is Ihe ploperly in questian:
❑ Real Property ❑ Mo6� "—�I.
— � -s � . �a.:.� 44�
. • 3 � '' \O.••
— D►'���;�Ci;�,.. � ..
. ' ��� : �. � ......
��.t.' .
C�i"d ��• .............. .
''aoll �O � 600
(� /
Disiricll �'�� 1.. ...w��onpraperly
1 �cer!
�� I ❑Yes ❑No
COUNTY AUDITOR
2p _ 20 _ 20
cwnry
20 _
Date (rteonfh. day, yea�
20
I/ We certify under the penalty of perjury that Me above and foregoing infortnation is We and cortect and ihat the applinnis was I were a resident of
Indiana and ovmer of the afwementioned property on March 1, 20
�.ra4ue (owne/s fidl name) Date (rlqnN, OaY Y��
Pason
stafe. arrd ZIP mde)
arby1C61.
person (num6erarMStreeCdty.sfate.
Date (monN, day,