HomeMy WebLinkAboutMortgage_Harvey^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C T p Year
___ � FOR DEDUCTION FROM ASSESSED VALUATION
� • State Form 43709 (R77 / 6-09)
�` � � p�esvip¢C py Departmenl af Local Government Frence
wsrRUCnoNS: MAY F`��12
Fortn Ned with:
To 6e lled in person or 6y mail with Ihe County Auditor or Counry Recotder o( fhe wunty where the property is located. C�,M
Fi7ing Dates: 1) Real Property: Must file during the year hr which fhe deducUon is sougAt. u AudiNr
2) Mobde / ManNactured Homes not assessed as Real Pruperty Must file during the fwefve (72) rtwnths ❑ q gemrd
beforeMarch3lo(eachyearthededucfionissoughG GIBSONCOUNTYA TUR e�
See reverse side for addrlional instructions aM qua/i�cafions.
Ao06wnt(ownerarFMk�buyer-seerestiirlionsmre�+rs,gside) f� � S�
Aaessed �ralue d eeal PmPerg' as d
Marti� 1. NrterR'Rar
II m. whal is his / Mr e�oct share OI inb
If nazre an recOfd i5 tlitfMrnt tlNn Nai c
�ame of rtqrigag a mntraa selle�
Add�es of mortga9 e w mntrad se�er
Name of assianee or other owner or �d
20
=�a�d� -3 -�e��q-o
Mortnage / Contraa indebtedness unpaid a U Mortgage / Contrad
Mamh 1, arren� year date af appliration
�
rc ow�d wiN somew�e ou,u
apptirant. 6Micate bebv`
�%
nu�ri and stree4 �dY. �te. aM ZIP oodej
of assignee (number aM streel, ray. slate. and ZIP cotle)
sigfuwre ot
ama,nt oe
20 _
It yes. what muMyt I w
COUNTY A'
20 _ 20 _
��b
R¢rnrd numbu Page numDer
a a �
ss unpaid as of Is Ihe applk'ant Na sole
kgal r uilade owne!?
Yes ❑ No
f. indkate with whom
P�PenY in puesDOn: MmiaM P55e55N
�1 PropeAY Q Annually 0.SSe55ed . . .
v,��,����-.io...aol a-
Card i1�0. .. � 313 .
. .................
��, I a�-5�
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daY. Yse�)
P�Y
❑ No
20 _
I/ We certify under Ne penalry of perjury that ihe above and foregoing infortnatian is We and cortect arM that Ne applinnt is a resident ot InCiana and
owner I wn cl buyer of the a(orementioned perty on date application is filed.
( Data ( day, yea�
��/ � �f% .i i % _ � 5�4� 2
E Sf4+
Dy tluy executed Power
142-0]
o�aWwrtredDerson (numberarrd5tree4dry,5tate,artlZlPCOtle)
Date (monN, day,