HomeMy WebLinkAboutMortgage_Gibson.��•'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
A FOR DEDUCTION FROM ASSESSED VALUATION
�• � State Fwm 43709 (RS / 2-07)
�'�; `� Presaibed by Depahmenl of Local Govemment Finance
ark
INSTRUCTIONS:
To be filed in person oi by mail with the CountyAuditor o/the county where fhe propeRy is located. � MAR 1 3 2��9
Filing Dates: 7) Real Properly: Dunng the 72 months be/ae June 11 0l the year the deducUon is to be eRec6ve�
2J Mobile Homes assessed under IC 6-1 J-7: Behveen January 15 and March 2 of the year the deducGOn is to be eflective.
See `everse side for additional insWCtions and qualifications. ,/
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IApplicant(ownerormnhad6uyer-seeresfnclfonsonreverseside) � ' A ` pIBSON COUNTY AUDITOR
.� n �-, �
oi ca-/ - '/ o `
poperty as d Mart�h 1. curenl year Matgage / Contract in
what is his I her exacl share of interest?
If name m record is tlifferent than ihal of applicant, intlipte below:
Name af moriGggee or conUact seller
w mnlraci seller (number and street, tity, state, and ZIP
of asvgiree w a�her oarier w hdder of mMgage
Address of azvgriee (number arM sfieet. city. state. eM ZIP wde)
Does applicanl awn praperty in any other
counry in Indiana?
❑Yes � No
Deduction appmved in the amount of:
� .j���
number I Pape number
as of March 1,
It owned wilh someone dher than spouu, indicate wi�h whom.
or eq�nuae o.mer
❑Yes ❑ No
Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.
D1"aNel' \TQ °Z DOa,�,!� f�
Card NO. .....:� ................
If yes, wliat counry7 What Ta
� COUNTYAUDITOR
20 2b 20
County
20
�Y.
�m
❑Yes ❑ No
20
I I We cerGfy under the penalty of perjury that the above and toregoing infomiation is true and mrtect and tliat ihe applicanfs was I were a resident of
Indiana and ovmer oi Me aforemenfirned property on March 1, 20
inawre (owne/s full name) „ /1 / Date (monfh. day. yea�
Fu0 resident addr� of a�plicant (numberand sbeet cify. sfafe. aM Z!P cvde)
X� 3 3� 1�/ �/Orl S�i'iiic � T�� yl
Person authonzed by tluly execuled Poaer of Allomey or by IC G7.1-12-.07
person (numberaMstreel.aty.stafe.aMZlPcvde)
Date (monfh. daY. 1'��