HomeMy WebLinkAboutMortgage_White (5)�
�
.� �'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,, . FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R8 / 207)
�'�;, j Presaibed by Departmenl of Local Govemment Finance
ie a
INSTRUCTIONS:
To be �led in person or by mail wdh the CountyAuditor o/ the county where the property is located. �
Fding Dates: 1) Real Property_ During fhe 72 months be(ole June 17 0/ the year the deduction is to be ef(ective. A p R. Q��
2J Mobile Homes assessed under IC 6-1.1-7: Between January 75 and Ma2A 2 o/the year the deducCon is o ve.
See reverse side /a additional insWctions and qualifications.
Applicanl o er or mnfrdd r- see re "� s m reversa sitle)
� �/J}//��� � //,Y/j'Q, t �,(y �p) GIBSON COUNTY � ITOa
Tapn 9ri Key number I legal desoiplion
- / - D- GO - �C1 /. 0- Oo7
Acsessetl value of 2al as of Mamh 1, curenl year Mortpage / ContrgU indebledness unpaid as M March 1,
cu�ent year l)
(% Q
' ro, what is his / hei eaacl share of imerest? If owned wilh someone oU
I reme m record is diReren� �han Ihat of applicant, indinle 6elow:
Name of mortgagee or conlracl seller ��
Address of rtqitgagee or conUad seller (numb and sVeet, dty, state. and Z/P code)
a dher owner w hdtler of mwigage
Does applicanl own yoperty in any Nher
counry in Indana?
❑Yes ❑ No
�
Signalure
0
ZIP coJe)
If yes, whet counryl
rS��
Whal Texir
Remrd number � Page number
is �ne �dmm u,e sae i�ai a��aae �r
❑ Yes ❑ Na
spouse, iMicate wi�h whom.
�Is N property in queslion:
eal Property ❑ Moble Home pC 61.1-7)
D�-:�„ ��- � o..a.9.T..1. z?.J
C,�l.� �Q� ,� �/ .�...
... �.
0 Q i
COUNTYAUDROR
�1��
caunry
20 _ � 20 _
o�e��anu,,eay,yeaq
20
�Y
� No
I/ We certify under the penalty of perjury that ihe above and toregoing intortnation is W e and correct and that the appli�ants was I were a resident o(
Indiana and owner of the aforementioned property m March 1, 20
ymt4re (owner's lu/1 name),� �.� Date (month, deY• Y��
�esidenl address of apq"K
�3ro r�
Persan authonzed by duly ex�
Atltlress of aulhoraed person
rmber and sGeet cify. sf fe. aM ZIP wde)
�D S �r:�ezt.
Poaer of Altomey w by IC 61.1-12-.07
��