HomeMy WebLinkAboutMortgage_Sullivan.+"•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o�n � Year
��FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fwm 43709 (R8l 2-07)
°�;- � Presaibetl by DepaAmenl of Local Govemment Finance
�L i
INSTRUCTIONS: Fle ark
To be lrled in person or by mail with the CountyAudifor o/ fhe county whe/a the pioperty is locafed. � -�
Filing Dates: 1) Real Property: Dunng the 72 months be/ore June 17 0/ fhe year fhe deduc6on is fo be eflecGve. l/ �la ����
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maroh 2 o/the year the deduc6on is to,be effecfive.
See reverse side for addifional instructions arrd qualifications. GIBSON COU�TY AUDITOR
Applicany (o�er w aur7acTdryer - see reshicfions m/everse siCe) ) `
: � d - 0 5 � ��,- ,S.oD �� D0
value of real property as of March 1, aurent year Mongage I Contrad indeWedns
QIR2lIlYEdI _ � _
' whal is his I her enaG share of interesl?
name on record is differenl Ihan ihal of applicant, indiote below:
mortgagee or conUact
Address ot mortgagee w
Name of assignee w olher owirer or hdder oF mortgage
Address M as4gnee (number aiM sLeef, dty, �ata. and
DoeS applicant wm property in any Wher
courriy in Indiana?
❑ Yes ❑ No
Deduction appmved in Ne amaunl of:
�
SignaWre af Counry AudMr
�
yes,
20
state, and ZIPcoOe)
20
a-�a -Od �
fid as of March 1,
If owned wilh someone olher than spouse, indicate with whom.
w equi�dde qm¢Y
❑Yes ❑No
Is ihe praperty in quesUOn:
❑ R�� a�Y ❑ Mobile Hane OC 61.
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D1'�\VCI' h�
•` �Y
�, �CardNO.,.{••••:•:•�,.�f---�• �r,o
�-�� l/I �'� 9/'�/, o� _
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20
20
20
I I We certify under lhe penalty of perjury ttiat the above and foregoing information is We and corred and that Uie applic�ants was / were a resident of
Indiana and owner of ihe aforemenbmetl propeAy on March 1, 20
-n,�aWre(owners/ullneme rY� � � Date(monN.deYY�A
� '� �l,u. n ��C)ii,�A.i�U,-...✓�
rev enl atldress of applicant (numbe� an0 sGeet. crty. sfata, aM ZIP mAe)
IC
e I Date (month. daY. Y��
Adtlress of aulhar¢ed person (num6ei erM sfreef, dry. stafe. aM ZIP oo0e) - �