HomeMy WebLinkAboutMortgage_Wagner (4)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ ,= FOR DEDUCTION FROM ASSESSED VALUATION
. � StalB FOrtn 43709 (R11 / 6-09)
S�.,� � PreunbeA by DepaNneM a( Laal Govemment Frenca
�S7RUCTIONS:
!o be filed in perSOn a 6y mail with the CountyAud'ROr or Counry Recorder o/ the county wheie the pioperty is located. F�
Filirg Dates: 7) Real PmpeRy: Must fiJe dunng Me }rear for which the tleduction is soughL (�EC 1
2) Mo6ile /Manu/actured Homes rat assessed as Real Property: Musf file dunng Ne lweHe (12J months"
6efore March 31 af each year the deduction is sought
\ C .'J.
See reverse side (oC add'rtronal instplctions arn! quafj(xatpns. 1
Year
County Recorder
it r a o �qsr/�mns «� ��sejme�
cyJ �L� �1/} L�/ GIBSON COUNTY A
1' Key iwwrt�ber I 1eg21 desaiption Recoid numbel Page numbPi
� �L-� - -_ � a� 1. 38' d 2,0 (o s 5
d ralue of 2al qoperty as of �b�a ge / Contract 4deMe,Wne55 unpaid a of Mwlgage / ConUact' ebtedness unpaid az d h Ne app(xant Me sde
, qyrenl yrar Ma� 1 wrtent year �` tlate of apP�� �e92� a eWilade owneR
QO V ❑ Yes ❑ No
at's his / her exaci share of interest? If awned with sameone dher Can spouse. mdicate with whom
on remrd is Cillemn[ than that o( aDP�nt. 6Mitate 6ebw Is ihe property in 9uestion: Mnualty ASSessM
PmpeAy ❑MnuallyASSes�
Modle Fiome IIC 61.1-i
Name a rtnrtgagee ar mno-act
�
Aildress of mat9a9ce ar contract
cily, sfate. eM ZlP code)
Nam¢ W assignee or other owner or halder of mortgage
AEEress oi assgnee (number aM stree4 �1: sbte, antl ZIP cade)
Oces applirant ovm property in any aNn If yes, what
muMy in Indena? ❑ Yes
❑ NO
COUNTY AUDITOR
De�ucoan approueC in the amount
_`_ -- --_._._.-____.�_� _
Dra�ti•c .\'o..a�.� l. �
•Card NO. ....��5 -
, � I ��W .UU ........ _
Zp 20 _ 20 _ 20 _ 20 20 20 _
SigfaaNm W CamN Audi�or CoumY Date (/rmlh. daY. Y��
I I We certify under the penalry of perjury Nat the above aM foregoing infortnation is true and correc[ and that Me applipnt is a resident of Irdana aM
ovmer I contraa buyer ot the aforementioned property on date applicatlon is filed.
�owrefs ) Date (� CaY. Ya�
„u ��A ti�n,c� ��-/ l -�r �
FW rrsitlent address d appGcarit ( u r and f, dry, sfate, and ZIP code) �_, ���
3� � �2��rc�-rvnl 1�1
iWy executed P�wer af AitaneY w by IC 67.1-12-0.7
person (number aM strcef, tlry. s7ate, and Z!P code)
Nama
(rtanth. QaY.
RECEIPT FOR FILING
Date (monN. daY Y��
lJ / V