HomeMy WebLinkAboutMortgage_Greene^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,,__ FOR DEDUCTION FROM ASSESSED VALUATION
� • Sfate Fortn 43709 (R11 / 6-09)
� , P2unbed by Departmertl of Local GovemmeN Firence
� File Ma
�vsrRUCnoNS: F �
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To 6e filed in person or by mail wiN Ne CountyAUditor or Counry RecoNer o� the counry where the pioperty is located.
Filirrg Dates: 7J Real Property: Must �!e dunng �he year for which fhe deduction is soughf. C� unry Auditor
2) Mo6ile / ManulacNred Homes irot assessed as Real Property Must file dunng the fweHe (12) months
6efore AIa2h 37 of each year Ne deducbon is sought. Recordu
See(eversesideforadditiunalinshuctionsandpualificahons. GIBSON OUNTYAUDIT
Appfir�(ownero�mntrarl6uyer.seereslri�.0ons vtlej � � ..
euct
If nartre pt
Nartre ot rtnrtgagee a mnUact seller
ACdress of rnntgagce w mntrad se0
7 O —(� / — C/IV-/ — L.�'m'
Mortpa9e / Contraa'viCebteOness unpaid a W
Marr}� 7. n�rtent year .
a7P6ca^t• uWicate bebw:
shee4 ury. sbte, arM ZIP code)
AEdress of assignee (number arM stree4 �: stafe, and ZJlJcaie) "
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�oes applitant vwn property in any dher yes,� what munry?
munry in Ind'au? ❑ Y�
❑ No
DeducGOn approved in the amounl of:
�
Whal Tapng Da1na?
zo _ zo 2o zo _
Sgriawre d Camry AuEitor Caunry
1/ We cert'rfy undv Ne penalry of perjury that the above and (oregoing infortnalion is t
owner I contract buyer of the aforemerrtioned property on da[e appliration is filed.
sigrature,jownersrwneme) -
Fup Rsident a0dress W appficant (ny� ber and sUee( oty, state,� ZlP m
� � 0� t,� YO p � 0.� ri-. �
Person autla(rzeC by CWy executeC of AttomeY or by IC Gl.t-12�.7
� Pdtlress o! authwaed person (numOUaM svee4 dry. sbre, aM LP mtle)
Reco�d number Pa� e mbPi
�� Q
Eehtedness unPaid as d Is Me appl'irant Me eN°
00 � ar M�itade ovmef?
� ❑ Yes ❑ No
an spouse. iMicate with whom
WoPenY in Queslion: Mnua�y Assessed
Real anoaero ❑ tvmualy AssesseA
Modle Fim�e (IC 61.1-7
Has Uus tleCUUim Eeen reCUested m p�oprny
r�a�� n „e� n
Dra���ei• NO...�Q/ o'� --
c�,-d vo. ... 5 5 0 -
................ �
1�n1 �k �
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Date (mon(h, daY. Yea�)