HomeMy WebLinkAboutMortgage_Spore (3)ry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year .j/
r—
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn 43709 (R11 / 6-09)
�• 1 Preuri6eE by �eP��rrt o( Lad Govemment Finaxe
File Mark
wsrRUCnoNS: JUL
b 6e (led in person a by mail with the CountyAuditor or Counry Recorder of the munty whele the property is bcated. �
F7irg Dates: 1) Real Pmperty: Must file during the year (or which the deduUion is sought C. �, unry Auditor
2) Mo6Be /Manufactumd Horrms rrot assessed as Real Properiy Must Ae dunng Me nveNe (72J months
6etore March 37 of each year the deducMon is sot�ht. unty Remrder
See reverse side foraddifional instructions aiMqualilcafions. GIBSON C
ed rahc d re� p�opgty as d
1, ameni year
If M. Wh3161ti5111Ef 8iTC15f�2f0 Of NiCf25i?
—V I � JV
/ CanVarl iMebted�
v�rerrt year
� `l . �. 9
If name on 2�ord is 6Rwrnt Ihan Nat o/ appfwant, 6WUate bebMc
a oontrae
,,-.,�.,�,
state,
Name oi asvyiee a otl�er owner or holder of npngage
nEdress ot assigtmx (number arN stree4 dN. �te/. a'�nd LF code)
T i-
Dce5 e�m oxn poperty in any oNer If yes. wh2l munry?
munry in IMana?
❑ Yes ❑ No
COU'
DeducGan approved'm tlre amount of:
20 20 20 20
I/ We certiy under Ihe penalry of perj that the
owner / mntract buyer of the afwementioned pro
state,
Person aufin�d Gy dWy executed Power o(Altnney m by
perso^
Remrd number Page number
_oo,.vva--o a as 8
nPaid as U Morigage / CantraG 6deMedness un7� s d Is ihe a00�� the sde
tlafe M apP�� kga� w equitade ovmM
❑ Yes ❑ No
� �°�
20
IS IM G�VertY rtl QuGSflal Mf1U2OY A152SSCd
❑ Real ProPenY ❑ %�Y �
MobBe Fim�e (IC G
� S ��= RDt� p --
SI-� E?'LA� A
I I-as�g��.
20 I 20
(id foregoing infortnation is W e and correc[ arW that the applicant is a resident of IrMiana arW
da[e appiication is filed.
Da� (nmN, day, yee�
��
Date (nronth, daY. Y��