HomeMy WebLinkAboutMortgage_Chambers.a "^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RB / 2O7)
�� f Presaibed try Departmenl d L.ocal GovemmeM Firexe
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� � �jle Mark
INSTRUCTIONS: i t� �–�{ 8 �
To be filed in person oi by mad with the CourrtyAuditor o/ the couMy wheie the property is bcat —1 ";� � �y
Fd'arg Dates: 1) Rea! PropeAy: Dunng tlre 72 months belore June 17 0/ the year the deduction is be e trra.
2J Mobile Hwmes assessed under IC 6-1.1-7: Behveen January 15 and March 2 o/tlie year Me deducGon is fo be e/fective.
SeereversesideloradditionalinsWCtionsandqualificafbns. NQV 2 1 ZQ�B �
buyer-see
S(�B%
� a r' nerr��,i "� '���•vL��O f, GIBSONCOUNT 'A.°YCR� •�Lj......
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Assessed value of real praperty as ot Mard� 1, airent ymr MM�d9C / C011I�2L1 IMBblEEl1E55 llfiP31A 25 Of M2lCh 7, IS U18 d�llmlil UIB SOIB IC921 IX BQUI�2hIB OMTe�
UIRCM }Pn1f
L b ❑ Yes ❑ No
IfL �� is hs / her exacl share ot interest? If ovnud wtlh sort�eone dher Uan spcwu. vidicate wiih whom.
m rearA is d'Afetenl Ihan lhat
Name af morlgagee or
AtlOress of moM1ga9ee or conVatl seller (numbu and sbeel, oty, sfafe, an0 Zl�code)
Name of assg�rea w dher oxner or hdder of mortgage
Address of assi9rree (rncnbe, a�M street, dty, Aate. arc
a(���yp� S�Iy'1
Does applicairt own propeNy in arry dher N`""" g
cauruy in Indiana7 }l , 1
�Yes ❑ No �1 1�1 I i y�(o .°°— -
Deduction appmved in Ihe amaunl of: ��� �
20 �__ � 20 _ � 26 _ � 20
of Counry fwditnr
20
Is Ihe propeM1y in question:
0 Real P�opertv ❑ Mobile H«ne (IC 6-1.
�
Date (rrmth,
requesled on pmperty
❑ Yes ❑ No
20
I/ We cerGfy under the penalty ot perjury ihat ihe above and foregoing information is true and correct and tliat tlie applicants was I were a resident o!
Indiana nd owner of the atwementirned property on March 1, 20
ina�wa� wne/s nAname) � � oa�e (monm. aar. r��
straet
m,y
pelsan (numbe�andstreelWy.sfate,aiMLPoode)