HomeMy WebLinkAboutMortgage_Bertram (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
: FOR DEDUCTION FROM ASSESSED VALUATION
`r=' . ,• S1ate Fortn 43709 (R11/6-09)
�` f p�gQ�p� py pe��yM af Loml Govemmenl Firence
�� File Mark
JSTRUCTIONS: , n
To be �led in person or by mail with Ihe CountyAUdito! or Counry Recorder ot Ihe county where the property is located. Q r
Fifmg Dates: 1) Real Property Must file dunng fhe year for which the deduc�ion is sought. County Audimr
2) Mo6i7e / Manu/actured Homes not assessed as Real PropeRy Must file dunng the twefve (72) monfhs C�`�
be(o�e Mamh 31 of each year fhe dedircfion is soughG ^f1 Rec°be�
See reverse sde (oreddilioRal inshuctlons and qualifications. GIBSON COUNTY AUDITOR
�NO&ant (owner w contraC D r_see_lesfictautt m reverse ' � �
't 1 b Y'
Aa�eO vahie cf rnal praperty as of AbMage / Cont
Marti� 1. aama year Ma`di 7 r2py
1
If ro, what is his 1 trer erad share of interest?
If name m remrd is dMUent Nan �hat of a0ptirant, hMibte bebw:
Name o( mmgaqee «cmtraa seoer n
RemN number � Page numGu
• o o�ir
��ress unpaid as W Morigage 1 Convap indebtemiass unpaid as d Ls �he appGvnt Ne sole
date o( appG�atmn kgal a equita6le ow�!!
a ❑ Yes ❑ No
If awnetl wiM someorie aher Ihan spouse. iMicate with whom
Is IM P�GenY in OuesGOn: MnuaM Pssesse0
❑ Real Property ❑ Mmually Assessed . _ _
Address N rrortga9ce or cmtrad se�er (nurr�her end strae4 city, slate, arN ZIP cade)
oMer owrier or hdder of npngage
(numDer aM speeG �: s�te. entl
uoes apµitam wm popeny in arry
counry in Indiana? ❑ Y�
20 I 2(
s9�awre or
.'___ �'_�N1atTeringD'stritl7
D�•a�r�er i\'0...��/
.....
Cai�d NO. .....�(�,.�?.l /
— C�5�go �.........
20
Has Nis deductia�
(M W rtEfl� }'fdN
r�
���,�,. �Y ��,
m p�opelty
❑ No
20 _
1/ We certify urWer Ue penatty oi perjury that the above and (oregang information is W e and cortec[ arW that fhe applicant is a resident of Ifdiana aM
owner I contraq buyer of the afo2mentioned property on date appfication is filed.
�9R?Wre (oype/s futl nartre) Date (rsmfh. daY• Yaa�)
1' 1 % l�.- ---
dry, state, antl
6
by O�y exew:ed Power
0
P4dress o( auNwaed person (numbe� aM streel, dry, state, aM ZIP code)
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