HomeMy WebLinkAboutMortgage_Adams (7)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN o n 7ownship Year
_�__, = FOR DEDUCTION FROM ASSESSED VALUATION `J;
Sfate Fortn 43709 (Rtt / 6-09)
�' �.» � Presmbetl by DePartment of Local Govemment Frence �
wsTRUCnoNS: APR 2 6 2� File Mark
To be fifed in F0�'� m� �:
person w by maii wiUr the CountyAUditor or Counry Recorder o/ fhe county where the prope �
Fd"mg Dates: 7) Real Pmperty Must file during Ne year /or which fhe deduction is sought C� � unty Auditor
2/ Mo6de / Manufactured Homes rrot assessed as Real Pioperty: Must file dunm� the fwelve (12) monN
betore March 31 o/each year Ihe deduclion is soughG 1Y AUD T� County Recorder
See reverse side /or addi[qnaf'In�strucfions and qualdications. GIBSON COUN
� .-�
IAppGmm(owne�orcorvra buye�- §re�r�trecbons re sitle) , _ ,
- 0,fi � n U Key numherJ,�egal desmpE
u U 10 I�l
d reWe of real p er,y as of Abrtgage�t
Ma�M 7. p�rent ypar Myml� 1
I
If no, what is his I her e�d share of int�st?
If rwrie on remN's dMrlent Nan Nat of appbrant, ciCiafe belovr.
Name of mortgagee a mntraU seller �/
u:�:t.�u
Name
7 -U7d a1�6 -�a7. . _._._.._ ._..._
e6 unpaid az of Mwtgage I Contrad iMehted�sx unpaid as d Is the eppli�anl ihe sole
/'�� Oate of avP�� legal «equita6le owneR
� V (J ❑ Yes ❑ No
If owned wiin someone other Ihan spouse. iMkate with whom
state, aM LP
Adtlressofassign L(�il�i'Cl� �tO,,,,��1
.......
Does applinnt ov
��,�,�g�: ����� .�o. ......�ya
........
� l�,�o.�
De�iuction approveE In the amount of.
20 I 20 I 20 I 20
wna� ra��y oam�?
20
Is the pmperty in Question: MnuaOy Assessed
❑ Real RoPeRY ❑ ��Y��
Has Ihis dedudim Deen requesteE on property
fw arrent yeaR
❑ Yes ❑ No
20 I 20
1/ We certify under ihe penalty yyperjury ihat the abov9$nd foregoing infortnalion is We and cortect arW Nat the applinnt is a resident of Indiana arM
owner / mntract buyer of ihe atorementioned pmperty `� date applicatlon is filed.
7naW2 (o e/s fiAI name) � Date (monfA. daY. Y��
ss of ap�pf�ira)nt (num7ber antl stleet, cil}; s1a ar+d ZIP m
�� ✓V ld � � ��[n/C`e
Gy diAy executed Power of Attorney or by IC G7.1-12-07
sd person (number aiM street, dry, sble, aM LP cotle)
Date (monN, tlzy, ysa�
y