HomeMy WebLinkAboutMortgage_Agee"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tawn:
_ : FOR DEDUCTION FROM ASSESSED VALUATION
�, State Fortn 43709 (R71 / 6-09)
S ! PresaibeE Cy DepartrieN o( lnfal Govemmerit Firiarce
F a
INS7RUCl10NS:
To be filed in person w by mail wifh the CountyAUditor or Counry Recro�der oI the counry where tAe pmperty is located. Form filed x
F�fig Dates: 7J Real Property Must fJe durnig the year lor which the deduction is soughL MAR 2�� �
2) Mob�7e / ManuFadured Homes not assessed as Real Properly Mus! file dunng !he tweNe (12) rmnths
before Maich 31 of each year the deducfion is sayht.
C .'J.
See reverse side lor additional instructiw�s and qualifications.
�"��ON"�f°L9" "�` �OOfB� � GIBSONCOUNTYAU
T istrrct Key �wm0er/ kgal d Record number
w
6-i o- .aii- �
Assessed vaqie o( real as of Abrtuage / Cantra¢ Indebtadness unpaid as d Mortgaga I ContraC iMe unpaid as ol Is N
MarM i, �vmrt year March 7, nrtrent year Eate af gppjication kga
�
tt ro, what Is ttis I tre'�
If reme on �ecad'¢ �
Name of rtnrt�agee a cmtract sNler
Address of mortgagee w cantrad se0er (number aM
Name of assignee or atrel awner w holtler W mortga
AAdress ol assignce (num6ei arM stree{ tlly, slafe, a
��
�ounry Auditnr
Counry Recorder
PaBe
Yes LI No
Is the P�Gert1' in Ouestim: MnuaoY Assessed
❑ Real Roperty Q Armually PssesSed
Modle Home OC 6
Does appli�ant ovm WnP�Y in any dher If ye '.' ' "'_. _ : Nis deduGion Eeen requesfe0 on P�P�Y
counrymlMena? ❑ Y25 ❑ No nO//- 9� a vrtentYra/� ❑ Yes ❑ N�
����lli�' _'_ vl
p¢EuGion epp�oved in Ihe amounl oE
zp _ 2p � � 20 20 _
Sig�NMe d Camty Auditor Date (mdrtM1. OaY. Y��
I/ We certfy under �he penalry oi perjury that ihe above arM foregoing infortnation is true and correc[ and that the applinnt is a resident of IrWiana aM
owner I contrad buyer of the aforementioned property on date application is filed. •
Fu�revEent adOmss d appGnnyf�umDer and �eeG ory, state. and Z1P m
Pason aulMtved by OtAy e�[ecuted Fw'er d AttnneY a bY IC 61.t-12�.7
Pddress of aWror'ved per'..on (num6erard street ciN. s+ate. anE LPmde�
Date (montt�. 0ay,
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