HomeMy WebLinkAboutMortgage_Tenbarge (13)^� STATEMENT OF MORTGAGE OR CON�'�,I��P�S
. FOR DEDUCTION FROM ASSESSED V A�I N e�
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Slate Fom� 43709 (R71 / 609) � gJ
�' Presui6ed by DepartmeM of Local Govemrtrenl Frence
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Coun Township Year
wsrRUCnoNS: NOV 2$ 2011 File Mark
To 6e filed in person or 6y mail with the CountyAUditor or County Recrorder ottfj9Wypty_wAe� tAe propeRy is located.
Fitirg Dates: 7) Real Property: Must file dunng fhe year /or which the deductibrt is§b'
2) Mobde / Manu/actured Homes not assessed as Real Property Must file d" Ne (72) rtwnths
6efore Maich 31 of each year Ne deduction is sougAt.
GIBSON COUNTY AUDITOR
See reverse side /o�tional insWCGons and qualifications. _
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M. Wlld� 6 NS / 112f BY2CI
If narne m remrtl a E'iReren� Nan Nat of apptinnt, i�Winte beb�r.
Name W mort9a9ee m m�tract seller
Addtess of �mnJa9ee or mntratl
or ather owner or
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a�M sheet cily. state, antl ZlP catle)
Do¢5 epptinN own property in any olher
counrymind"ena? ❑ Yes
❑ No
DeAucOOn
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If yes, whal couny?
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��pae as w r.�«ya
Fortn f�ed with:
Counry Auditor
❑ County Reeorder
number � Page number
'vdeMedness unvaid as d I Is Ne aPd'�t Ne sole
�gal or equitade owreR
❑ Yes ❑ No
han spouse. indifate �viN whom
Is Ihe property in Question: Mnualy Assessed
❑ Real RoPeAY ❑ Mn�ailyAs�ed
Modle Hane fIC 6
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I/ We certify under Ne penalry of pe7�eiry that Ihe above foregoing intortnalion is W e and correc[ arW Nat Me applipnt is a resident of IrMiana ard
owner 1 mntract buyer of Ne aforemenboned pmperty ate appliotlon is fiietl.
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PowerafAVnnay
state,
Address of aWmraed persm (numberaiM snee4 ary. sbfi. antl
Date (mmN. dzY Y��