HomeMy WebLinkAboutMortgage_Birch (3)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n h Year
__„ = FOR DEDUCTION FROM ASSESSED VALUATION
� � � Stata Fofm 43709 (R71 / fiW )
i,.,. 1 Peeunbed by Department ol Lttal GovemmeN Frerrs M
INSTRUCTIONS: A U G F� /
Fwm filed with:
b be filed in person or by mai/ with fhe CowtyAuditor or Counry Recorder o! the wunry where the property is located.
Filirg Dates: 7) Real Pmperty: Must file during the year to� whicA the deduc[ion is soughG `-�-�, �County Auditw
2J Mo6de / Manutactured Homes rwf asse.ssed as Real Property: Must file dunng the RveHe (12) months!'�
bePore March 37 0! each year Ne deducfion is snught. ❑ County Recorder
GIBSON C
See reverse side 7or adtlifional instructiuns and qualifications. .
IADPGanY(aM*ierorY+ilydCDuYer_se4'fasfricao^su^Rye�$f) .1 �..
sessed va4x d real poperty as of
ert�h 1, a+rent year
ro. whal's his / her e� share OI
name m remN's dfierent Nan N
iber I Iegal eeSGiption
Abrtga9e / Contract
belrnv
Name of nnrtgagee or mnvaU seller �/�J"�
\/
Address of rtart9a�ee or contraG se0er (number aM streeG �+b, state, aM:
Name af azsignee w oNer owner or holder W nprtgage
AGCress of atsignee (number srd stree; dry, sfefe, and LP code)
Dces appli�nt wm propem� in afry oUer If yes, what munt�/.+
�,�c� �� i�a�?
❑ Yes ❑ No
Draud'mn approved in tlre amount oE
20
Sywt�ue of Co�mty Autlitor
20 - � 20
iJ
az
Retotd
Is Ihe appfi�nt the sde
legal w epuitaWe awn�l
❑ Yes ❑ No
H owried wiN someone other than spouse. iMirate with whom
Is the property in Question: MnuaOy Assessed
❑ Rea� aropeny ❑ �vmua�y assessed
Draiti•er r � — --
1�� q
Card �O 3..�'b! —
8yo
,�„ 5�3 "� •��. . , �
, ayo '� ❑ No
20 � 20 _
Counry
�_
Date (rtronN. daY, Y��
�
I/ We certify under Ne penalry of perjury that the above arW foregoing infortnalion is W e and correcl arW that ihe appti�ant is a resident of I�iana aM
owner I mnVaU buyer of the aforementioned property on date applicatlon is filed.
��anue.fowra/s lutl namel %l . Date (month. daY. Yaa�)
tlry, state,
cY ic ��.
Pdtlress of author'vN persan (number a�M streel, ciry, sfafe,
r'nc��-on �N tl-�670
o� c„�mm, ear r��