HomeMy WebLinkAboutMortgage_Gilmore""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 7o Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
- State Fortn 43709 (R71 / 6-09)
�' ,� Presaibetl by DepartmeM of Local Govemment Fuaxe ��
wsrRUCnoNS: ,j��Fi� �ia'�UIU
Form Aed wRh:
To 6e filed in person or by mail with the County Auditor or Counry RecoNer of the county where the property is located.
FiNng Dates: 7) Real P/operty: Must file durirg tha yrear /or which the deduction is soughL q�d���
2) Mobde / Manufactuied Homes not assessed as Real Property: Must file dudng Me hveNe (12) monfhs , 'l`G7� �o�� ecorder
betora March 37 of each year Ne dedudion is sought. GLJ ry
See reverse sm'�1qr additional inst/ucfbns andqualifications.
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rehx d rnal qop¢rty Mwtga e/ ContraG "vde6tedn�s unpaid as d Mortgage I ContrarY i�ebtedness unpaitl as of Is Ne app(rcant ihe sole
MaU 1, amnt 1'� Mard� �l OOT date o( aVP�� '�I ❑ Yese Q NO
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If ro, what is his! her e� share of inferestt If ovmed vriN someone other than spouse, indra[e Mith wfwm
If nama m femrd's dAte�enl than Nat al apP�L ��� belo�'. Is ihe property in QuesDOn: Mnualty Pssessed
❑ Real RoPertY ❑ Mmua��Y Assessed
- Mobile Hart�e IC 61.1-:
Name of mortgagee w mntract seAer _� �
ACdress of morcgagee w mntraU se0er (nwMa� and stree4 �: state. aM ZIP code)
Name of asvgnee ot othrs owner ar haNer
Adaress ot assig�a (num6er erd saroL my, s+ete,
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W Gounty aw�mr
Wha� Ta�drg Districc?
COUNTYAUDROR
2� 20
Counry
Mis detlumon Eeen re9uested m 7�Y
urtent YeaR ^ _ _ r-�
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1 I We cerGfy under Ne penatty of perjury that the a6ove and foregoing infortnalion is We and cortect arM Nat the applinnt is a resident of IMiana and
owner I contracl huyer of the afoieme�oned property on date appfiration is filed.
yaWre (ownersh�amg/ Date (month. daY.Yee�
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city, state, and ZIP cotle)
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by dWy ezecutetl P6wer o(Attomey or by
Address of authorrzetl person (number arM sbeet �Y. state. aM ZIP code)
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