HomeMy WebLinkAboutMortgage_Davis (12).t.�-,"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
�,°3�FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R8l 2-07) � �
�0�; '� Prescnbed by DeParlment of lacal Govemmenl Finance �
Fil
INSTRUCTIONS: �
To be filed in person or by mail with the CountyAuditor olthe county whera fhe propeRy is located. � MAK j y 2001�
Fding Dates: 1J Real Pmperty: During the 72 months be/ae June 71 0/ the year the deduc6on is to be e/fective. i
2) Mobile Homes assessed under IC 6-1.7-7: Behveen January 75 and Marth 2 0l the year fhe deduction is fo be eflective.
See reverse side /o` additional instructions a�M qualifications.
G�a�., �
Applicam(ownerorm b`ernsee� "�fi�nson�ve� de) ^ n , n GBSON COUNTY AUDITnR
In
�,��
�
is his / her exad share of inlerest?
If name on recwd is tl'rf(erent than Ihal ot applicant, indicate below:
Name ot morlgagee or contract seller
rW' �7 ��V�
} irWeWedness unpaid as aF March 1,
Address of moM1gagee or wnlrad seller (iwmber aM sfreet. riry. stafe. eiM ZlP code)
Name of assignee a dher avner or hdtler of mMgage
II
wiU someone other lhan spouu, iMiwte with whom.
Address of assignee (n�m�6eiaM sVaet. dty, stt
Does applicant own poperty in any dher
Drawer NO.��%Q,�,-, �,�7'S
counry in Inda�a?
❑Yes ❑No
Card i\'O
. .. �............
Deduction approved in the amounl of: ��� �/��� �� • O D
� `39aa.
� � _���
af Counry Autlitor
2b I 20
M Bt�utidde OxneYi
❑ Yes ❑ No
Is �he property in ques�on:
❑ Real Property � Mobile Home (IC G1.1
Has lhis tledudion been repuested on property
fa wrtenl yeafl
❑Yes ❑No
i
20 _
I/ We certify under the penalty ot perjury tt�at Me above and foregoing infwmation is We and mrred and that ihe appliwnts was I were a resident of
Indian d owner of tlie aforementioned property on March 1, 20
1naWr (ow rs /ull name) ^ / \ Dale (monN, day, yeaQ
A
7
cdy. stale. arb ZIP code)
or by IC 61.142-.07
of aultwraed peism (numDei anE s7eeL city. state.
de,;