HomeMy WebLinkAboutMortgage_Ricketts (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSEO VALUATION
State Fwm 43709 (R71 / 6-09)
� Prewibed M�7��M of LoW Govemmeru Firiance
INSTRUCTIONS:
To 6e filed in person a by mail wifh the CountyAuditor or Counry Recorder o/ tAe munty where the property is bcated.
Fiting Dates: i) Real Property: Must file dunrg Ne year for which Ne deduction is wught. J
2J Mo6de / Manufactured Homes nol assessed as Real Property: Must Ae dunng the hveNe (72J months
before MarcA 31 ot each year the deductnon is snught.
See reve side !or addifional insWCtions arM qualifications.
IApp&ant( ar 6uYer-me m
, �`�; A 1,`��`] a GIBSON
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If ra. whal h lus / Mr esaC
tl rWne an iemld'o CHterer
Nartre oi rtnrtgagm a mntrart sNler
Address d mortga�ee m m�traG se0er
Name ot sstignee a W�tt ormer or
Wtt
Mtl�s W auignee (nurnber artl s!
mortgage
u�am w,� arw«�r � e�y ome,
Ib�na? ❑ Yes ❑ No
�prorea m me amo�,H
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ad LP mde)
rc r�, �mat
0
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8 �'6ry��e�.
o �� ������ �a��
❑ Yes ❑ No
mmeone otlwi tlian spouse. udimte WN whom
is Me P�GenY in Ouestlm: M��e➢Y Asesse0
❑ F2eal PtoPertY ❑ Atmuallyl�se�ed
0.1od7e Fipne fIC 61.7-�
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; � �I �3'�7. �
e� Ra� d, wavacy
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2p_ 20_ 2p_ 20_ 20_ 20_ 20_
SignaWre o/ Camry AuOitur Couny Dete (rtwnfh. daY. Y��
� I/ We certify u�der Ne penalry W perjury ihat iha above and foregoing in(ortnation is true and correU arM Uiat ihe applipnt is a residertt of IrMiana ard
owner I contracl buyer of the atoreme9tia�ed P�nY � date appliration is filed.
P�sui auu�a�d M C�dr ezecutetl Fawe� NAttareY a �y I
AGCrm ot aWm'ved o� (numberaM sbeeG �4Y• sbm.
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