HomeMy WebLinkAboutMortgage_McConnell^'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_, : FOR DEDUCTION FROM ASSESSED VALUATIOf�—� ��
� c • State Fortn 43709 (R71 ! 6-09) 0p—�
� yw l Pr¢Spibed by DepaRment of Lncal Government Fu�ance g
q File Mark
�NSTRUCTIONS: MAY J 2012 FormAedwith:
To 6e filed in person w 6y mail with the CowtyAuditor or Counry Recorder o/ the county where the property is located.
Filirg Dafes: 1/ Real Pmperty: Must file dumg the }rear for which the deduction is sought. C ^n`;,3� v V � Counry Auditor
2) Mo6ile / Manulactured Hanes iat assessed as Real Praperty: Must file dunng ttie hvel 121 onths
before Mamh 37 0/ each year the deduction is sagh[ ❑ Counry Recorder
See'everseside(o`additionalinsWCLOnsandqu �ications. GIBSON COUNTY AUDITOR
pppfvant(ownerm �.%lii��n—T71 .-.�e��� fY��. � _ n \i
As�ssed vahie d real pmperty at tl
MeIU t. amein yeer
ir �o, wna� � na r n� exaa � oi a
11 reme m �ccad s 6Remm Nan Na
rlame or nnngayea «m�vaa sH�e�
neafess a n,onqagee «cano-aa sPn
Name of assi�ee w oNU wmer or 1
- i a - a -oc�. n�-� �
Hetlness unpaid as d Abngage I Contraa'uideOteAness impaid as d
EaM of appfiration
tt owned vri� mmeorie aher ihan spouse. IMicate wiC� v
app5rant, udimte DeWw:
�r
vur�6Pi end streel, cdy, s7a:e. aM ZIP code)
�r of morigage
tlry, slate, ard ZIP oode)
pwn property in any other I If yes, what
w?
❑ Yes ❑ No
approved'o� ttre amwnt
20— � p
COUNTYAUDROR
20 20 20
� �. �mY
V'�v � � l �lU `-1' V Y��
I/ We certify under Ihe penalry of peryury that e above and fo
owner I contrad buyer of the aforementioned property on date
Pelson aulhoiaed by Auly esecuted Powei o(AtlorneY a�' IC E7.7-12-0.7
Ptldress of authoraed person (number aM spee4 �'. stale. and ZIP fvtle)
�i��
', aPWirart[ the sole
n eWitade awndl
❑ Yes ❑ No
�S � a�ocem �� a�esrim: n�n�,anrwssessea
❑ R�i Provenv ❑ a�,�ny w5��a
Mas this tleAUd'nn
tor arrent yea(?
20
daY.Yea�
on propeny
❑ No
20
�rtnalion is W e and mrteU arW Nat the applican[ is a resident of Indiana and
� fil�.
Date (mwrth. daY Yaa�
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