HomeMy WebLinkAboutMortgage_Slade^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township �vear .
4 FOR DEDUCTION FROM ASSESSED VALUATION
:._—. -
Slate Fortn 43709 (R71 / G09) � � �
�' ,�„ � j Presaibed by oepartment ot local Govemment Fi�ance �
File Mark
�7RUCTIONS: F� �� �:
To be fiied in person w by mad with the Co�ntyAUditor or Counry Recorder oI the oounty where the property is located.
F7ing Dates: 7) Real Pmperty: Must file dudng fhe year for which the deducfion is sough j q 'n' � Counry Auditnr
2) Mo6de / Manufactured Homes irot assessed as Real Property: Must file ��ng t/le`(wfld� �2) months
6efo�e Marcf' 31 of each year the deduclion is saght County Remrder
c.�.m..�--
See reverse side /o�di�ional instru '�s arrd qualfications.
Apprnm(owner b�- ^� � sn) GIBSON COUNTY AUDITnR I
Marrh 1. a+�� y�
11 rw. what a his / t�
1( �2rtre at RCWtl 9�
.. a"�e-1���J^4
Mo�ge / Contrati irMebieOrress un�
Ma 1, artent year n� __ '
exae share of intelest?
Nan Mat of appGCanl,
IName oi rtwrigagea or mnttaCt seller __ __ _
Dra�v \e ii O . ���.�.,....
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ciry, slafi. aM ZIP codej
Card \0...�'.�.�......... ��
������.� �.
� ��� u rvo I
cUOn appoved "c� the amount ot
20 _ 20 _
I/ We certify under the penalry
owner I conVad buyer of the a1
�re (ownefs (W name) �
��
p adOmss ot appfxani (wr,
n ��� ��,1 M
r'mn authomed Dy duty ezecuted P
I Recortl number ( Page
q-ba�
az
If owned with someone otl�er ihan spouse,
counn/+ � wnat
unpaid as d I Is Ihe appikant Me sde
legal or equitaWe amM
❑ Yes ❑ No
Is ihe property in puestiw� MnuaDy AssesseC
❑ Real ProPeM ❑ MnuallyAssessed
� v�nr
❑ No
20 _ 20 _ 20 20 _ 20 _
County Oate (rtpnfh. aaY, Y��)
that Ne a e and foregoing infortnaUon is we and correa and that the applicant is a resident of Indiana afd
ned prop on date appliqtion is filed.
Date (montli. daY. YeaA
f„— Iq— 12
t�i1y, state, ard LP code)
by IC 61.
person (number aM strce4 �: stafe, an0 ZIP cade)