HomeMy WebLinkAboutMortgage_Barton"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES o - 7 ip vear
__ . FOR DEDUCTION FROM ASSESSED VALUATION
� � � Stata Fortn 43709 (R11 / 6-09)
,,w. Pfesmbetl by Depattrnerd af Loml GwemmerLL Finams F'
INSTRUCTIONS: D E C 2 �[�J ��f Mafk
To be fiied in person w by mail with fhe CounryAuditor or Counry Recorder o/ the county wfiere the property is bcated. F� �� ��
Filing Dates: 1) Real Properry: Must fife durirg the }rearlo� which tlie deduclion is sought �-y�. County Auditor
2) MobBe / ManWactumd Homes not assessed as Real Prope�ly Must h7e durirq Ne hveNe (12) moAlks�.,
6ePore MarcA 31 0/ eacA year Ne deducfion is sought. G Counry Recorder
See 2verse side (oradditional insWCGOns aMqualifications. GIBSON COUNT
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a+caa year
rurtre m
Name af mortgagee m m�tracl se0er O
X
AOdress W rtnrtgages w contrsG se�er (num6� and sveeG �Y.
assa,piea w amo vwner w maer rn mortgage
munry in Iritlana?
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any oNer
Yes ❑ No
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DeducCOn aOW� ci tlre amount oF:
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Syreture of Camry Auditnr
InCe6tedn¢s unpaid as d
aM LP wde)
-o a
e I Contr
mmeone dher ihan spouse.
beJ ���� SE� ���
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- a0<� ��� �-
2p _ � 20 _ � 20 I 20
Recortl numbPi I Pace number
as d is Na applirant Ne sde
legal w equitatle ameYl
n Yes ❑ No
tl�e ObD�Y in question: M�usOy AssesseC
�Real ProPenY ❑ ��Y �
0.bd'le Fbme (IC 61.
IJ
20
Gm Eeen requested m property
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I/ We certify u`Wer the penalry of perjury that Ihe above and foregoing infortnation is true and cortect arM Nat tha applitant is a resident o( I�iana aM
owner 1 contraU buyer of the aforementioned property on date appiication i� filed.
3naWre (o rmrtre) /J /J , Date (rtmfh. aY. Yee+)
3s of appfrcanl (nLmDar and shee4 �; s+ata,
Gv S�/, %tD.S ��"
author¢etl per:v� (nvmbcr arM sbee4 �; sbte, and ZIP code)
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