HomeMy WebLinkAboutMortgage_Bond^�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun 70�
__ � FOR DEDUCTION PROM ASSESSED VALUATION
� � • State Form 43709 (R77 /609)
��' ,w, F preurlpyA y, pepartmenl of Local Govemmenl Fnance
F
iNSTRUCT70NS:
To b filed " b mail with the CounryAud'ROr or Counry Recorder o/ the counry where !he property is located.
e m person w y
Filirg Dates: 1) Real PropeRy: Must file during the year (or which the deduclion is sought. Counry Audimr
2� Mobile /Manu(actured Homes rrot assessed as Real Pruperty Must file dunng the fweNe (72) monfhs PR s�}�, Recorder
before March 31 of eacA year the deduction is sought.
See reverse sidelorad Rional insfrucfions and qual"fiirations. '. -
Appficant(owner ' b �-see rsesid
GIBSON COUN
Ta�d �i KeY rwmber / leg tim RecoN n�
��o°-i� /._3- �O�f-o00.S�7-
qaps¢tl rahre d reai yopMy as N Mof(gage / videhteEness unpaid as of Mmtgage / Contract i'MeMedness unpaid as of
Mert�h 1. ameM Y� Martl� 1, a�� O D� tlate af a7PGotion
�� M �hat ¢ h's I her euG share of interest? tf aw�red w7M sumeane other ihan spouse. iMimte wRh wtia
on recoM is diRerent Nan Nat o/ aDP�t. 4Micate below
Name of mortg3ge8 or mnb'att seller },� /,
l� �u ,
Add�ess of mongagce or wnbaa seAer (nwriber end sbee4 �: �.
Name of assianee w ofher ow�er w halder of morigage. _
MGress of assignce (numberaM sfreet, dry. 5lete, anc
Does applinnt v.m poperty fn any oNer
tounry in Indiana? n Yes ❑ No
��7
amoum or.
20 � 20
llC�\1'C�' 1�..5!!5�!�1�/�........
Card \'O. ...�.�.,�...1. .• • •
�5�,�00. m
I I We certify urder the penalry oi perjurykl/at the above a
owner I contrad buyer of the afwementwKeA property on
jlgnaLUe ( x s hN name) /j � ��
X) � � E�l� �
�u0 revdeni aEE`ess o( appfi�nt number anE sLeet, ory; slate, arc
Y�„?oi s �2'1�,� 6f�
Person auNO�rzed by duy executed Power of At�omey or by IC 61.'.
AOdress of author'¢eA persrn (number aM sbee4 �: sb(e, and L
>plkant Na sole
equilade awneR
] Yes ❑ No
�s me wovem to a��sorc nrinuaM nssessu:a
❑ Real Roperty ❑ Annua��ytissessed
Mas Iha detlud'wn Eeen reGUested an P�W��Y
for artent yean
❑ Yes ❑ No
20 20 20 _ 20 _
Counry Dete (rtanfh�y, � / �n /�
ig infortnaGon is W e and correct arW that the applirant is a resident of Indiana aM
atlon is filed.
Date (r�mnUi, Eay, yeaQ
Date (rtronN, tlay,