HomeMy WebLinkAboutMortgage_Peyton"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
• Stale Fortn 43709 (R11 / 6-09)
�` ,,,, l Preunbed by Departmenl a( Lasi CovemmeM Fuunce
�STRUCTIONS: -
b 6e �ed in person w by maii wiN the CountyAuditor or Counry Rernrder of the county where the property is lowted.
Filirg Dates: i) Real Pmperty Must file during the year for which fhe deduction is sought.
2J Mo6de / ManuFactured Homes rrot assessed as Real Property: Must file during the fwelve (12) months
6e(ore Mardr 31 07 each year the deducfion is so,ght
See reverse side 7a additunal instrucGons end qualfications.
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�MOrtaane / Contract inde6tetlness unoaid az of rl
AlaiChi.axreNKar '
�i M. W�Id� 6 i115 ��IPl C%dfi 5�182 Oi YI}P125i�
It name m �ecord is 6RUenllhan ihat o1 app4
Plame m mmyayee «m+axt seuer �
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Address af rtnrtgagee a contract se0er (number and sLeel, ctry, state, aM ZIP codaj
Name of assignee w otha owner or hdder of mortgage - i.
MGress ot assignee (numba� eM street �; sfale, and ZIP cntle)
C�(�Auditor
Counri Recorder
GIBSON COUNTY
as
I Eete ot appGmtion I legal w epuita6le ox*wR
❑ Yes ❑ No
II OMTICE N1N SORICOfIC OCIPl CNfI $PpUSB. YlEK8I8 WIVI WMlfl
Is Me P�nY in Quesiion: MnuaOy As5e55e0
❑ Rea� aropenr ❑ iw,!,aMw�a
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" LJ Yes LJ No � , ' :. � LJ Yes LJ Ni
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g�ture U Counb Auditw Counry Da�e (month. day, Yearl
I I We certlty u�er Ne penalry of perjury ihat Ihe above and foregoing infortna�on is We and cortect arM Nat Ne appli�ant is a resident of InAiana arM
owner I contraq buyer of the afo2mentioned property on date apP���n is filed.
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Person aWnraetl Gy didy exewteA Power o(Attomey� IC 67.1-12-0.7
Pddress oi auUqraed person (number aM stree4 �fi: sbre, an0 ZlPCade)
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