HomeMy WebLinkAboutMortgage_Hormuth.•. "�"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�,, ., FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RB! 2-07) �-�
�5�;: '� Presvibed by Departmenl of Local Govemment Finance � �� g
J n s�
F a�
MSTRUCTIONS:
To 6e filed in person or by mail with the CountyAuditor o/ fhe county whera the propeRy is located. �
Fding Dates: 7) Real Property: Dunng the 12 monfhs be(ore June 11 of the year the deduc6on is to be eHective. p E C Q 1 Z 008
2) Mobile Homes assessed under IC G7.1-7: Behveen January 15 and March 2 o/the year the deduc6on is to be eNecffve.
See reverse side for additional insWctions and qualificafions.
J ,�,
Applicarri(� er or conVaq 6uyei - se re,y��p!�s m reverse sid'J/
�-l.� t Gl ,,, �.� �`N a�1n /VN n i�-6 GIBSON COUNTY AUDI70R
- �- _iv-loa-oc�o
Assessed value of real popaty as of Match 1, curent year Akxtpage / CanUaG iMeWt
artentyear �/
If o, what is his / her ezacl share ot i
i� me rn recard is difFerent ihan Na
Name oi rrangagee or contraU sNler
oi applicam, iMipte below:
Atldress of morigagee w �nntrad seller
Name of assignee or M1ier o.vner or hdW
m e
Address oi assignea (rxaMer and sLBet.
D__".wMw..,,., aooaM.in arry olha
G
martgage
stafe. antl ZIP oode)
If yes. whal count�?
_ Dra�r�er NO.. ���5 —
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Card NO. ....�.J,y� —
�7c�, ti a►i, � �' —
SignaW re of Counry Autlitwr
a -�a�
ipaid as ot Marc� 1,
with sortieone other ihan spouse, indicate with whom.
COUNTYAUDROR
20 _ 20
Couny
❑Yes ❑No
Is �he proparty in QuesUon:
❑ Real Pmcertv ❑ Mobile Home OC 61.
20
Date
uested an poperty
❑Yes ❑ No
2�
I I i
I/ We cerufy under lhe penalry of perjury that the above and foregoing infortnation is trve and cortecl and that the appGcants was / were a resident of
Indiana and owner of Ihe aforement�ned property March 1, 20
Dafe monN, day year�
�.�wre� nerslWlnarrre) i _ (
// � �[
Po.ver of Attnmey w by IC 61.7-
Address of aNhortzed penm (number and streeC aty. state. aM ZlP ootle)
Date (month. deY.Y�A