HomeMy WebLinkAboutMortgage_Roth"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ip Year �
; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (R71 / 6-09)
, P Presaibetl �y Department of Local Govemment F�nce
,� APR 2 ����dt��
wsraucnoNS:
k 6e filed in person or b mail with the Coun Auditor or Coun Recorder o/ fhe coun where the ro F d w'nh:
r b N ry a aertr is rocare� .'J.
Filiig Da[es: 1) Real Pmperty: Musf file dunng the year (or which !he deduction is sought. unty Auditnr
2J Mo6i7e /Manufactured Homes irot assessed es Real Pmperty: Must file dudng the tweNe (12) months
before AAarch 31 ofeach yearthe deduction is saghi. GIBSON CO NT U PPI.'JPtR��
See reverse side 7or atltlitional instruclions arW qualilcafions.
7 �.G�""' vP' - IJ — d�V _
Att� value d real pmperty as of Mor(qap e/ Contract'uMeh'
'7e'di 1, a�Y year Mamh �. artent yrar
I( no. what S his / her eract share of interesl? ��T
It name m reoo�tl's E'itterent Nan that o/ aDp6pni, uM'vatc Gelaw.
Name of rrortgagee or contracl seller
� FT G [,�
Aadress oi mort9agee « wntrae seAU (nun6er ard stree4 �Y. ffite. eM �
Name of assignee w oNU awner or hdder of mortgage
Aderes.yqfassignee(numberaMStreef - .slafe.andZlPcode)
w v
Does spplip own popeM1y in any oNer If yes. what wunryR
oouory m �wana?
❑ Yes ❑ No
Deduction app�oved in Ihe amount of:
�
�fanne d Cmmb Aueitor
C•T.
�� we cewiy �ndu me'
owner I contrad buyer �
� /5 hIIl rert�
�"`J�'��- �
0 re/s�i�tlen�t a�d0�� ot �app�G�
�V � Ja /�' Lc 1
rsona oy/Nyezi
vi
aress cerwn
20 20
�enal ot perjury at ihe above ¢
f e m ti� ed property on
( Der aM stleet dry, state, am
�
-oa� ao�� Pi���°�'
lgage / Conbact irMehtedness unpaid as d is Ne ap��ant ihe sole
i of app4cation legal w epuilade o�me(1
❑ Yes ❑ No
someo�re oNer llan sW�+�. indimte wRh wtwm
�oPaM ❑rmrwa�Nws�ssed
awti�e r�n� nc ��.�
ll � a �ve�- �\'Q o� O �
What Ta�dng D'svict? • , /. ,
C81'Cf l\��. „ �/� � •.
aUDROR __ __ �' ' • . ,
20 � 20 ' � 20 � 2(1
regoing infortnalion is true and cortect arW that fhe applican[ is a resident oF Indiana aM
appiicatlon is filed.
Da�e (month, dzY. Yme�)
:ed P6wer�p AROmey w by IC G7.t-12-0.7
5_ Pi�.2on 7d.�eo !.� .
umberaiM t,dry,5fate,aMLPCOde)
Dale (monN. tlaY. Ysa�