HomeMy WebLinkAboutMortgage_Brittingham^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun1
_ FOR DEDUCTION FROM ASSESSED VALUATION
. • State Fortn 43709 (R71 / 6-09)
�` 2 Presrti0ed by OepaNnent of Local Govemrtrenl Firence
�STRUCTIONS:
To be fifed in person w by mail wi[h the CountyAuditw or Counry Recorder of the couniy where Me pioperty is located.
Filmg Dates: 7J Real PropeRy Must file during the year for whith the deduction is sought.
2) Mobde / Manufactured Homes �t assessed as Real PropeAy: Mus! file dunng the hvelve (72) months
before March 37 0( each year ihe deduction is saght.
See 2versa side for addifional instrucfions and quali�cations.
MWu� (owneror contrarl buye� see res�iftbns m reverse sitle)
Asmsed �ahe dreal P�P�Y az
MeTh 7, ar�ek ymr
It ro.
an
Nat of appGCarLL.
rUme o( �ee a cd„rxt uue, � U
PAEress of mort9a9ee w mntraG se�er (numbrf and sn
Name of assignee or oNer owner w twlder of mMgage
AdEress o1 assi9nee (number entl sneet �ry, sfefa, and
Does applimnt ovm property in any olher
�������a� ❑ Yes ❑ No
DeduUion appmved in C�e amauN oF.
20_ 2b_
Sig�wre d CamN aWrtw
C.-�
I/ We certify ufWer the penalry of perjury t�
owner I contraa b�yer of Ihe a(wementionef i
Year
A pn 1 OounMquditor
��j �CounryRemrder
GIBSON COUNTY
�� � qecoiy m�mbpJ Page wmber
_33_IOO-DO`f.oDY-Da� OO�j 9rb
;/ Contraa intlebcetlr�s unPaid as W Marl8a9e I CantraG udebtetlnrss imPaid as d Is ihe eCG�t Me sole
wrtent year date W aDP�� legal a equitade ox+�t
� 7 9 ❑ Yes ❑ No
It owned wiM somcone oiher Ihan spoum. i�dicate wilh xiwm
: bC�O`K I -�ti�__��M_
►�,� i a�oq- � 91 �
ee4 �: ��. aM LP code
ZIP code)
I( yes. what muntyt
COU
2p _ 20
above
fficet, dry, sfate, arM
�� i
`�a07, $93, a°
NTa� TaAMI \J � �-lL 9 l.. , C:! '_"`� /
� � (/�
a� �n�-�.��,�.
regoing infortnalion is we and cortect arM ihat Ne applirant is a resident of Indiana aM
applinlion is filed.
Oate(monfi,day,yee�
(monN. daY• Y��
auNor¢edpercwi (numberaridstree;aTy.stafe,andZlPcode)