HomeMy WebLinkAboutMortgage_Leek"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun
_,. FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Form 43709 (R71 / 6-09)
,,.,. � Pr�aibed by DeGamneril 01 Lafal GwemrtreM Firwce
INSTRUCTIONS:
b be ned in person or by mail with the CounryAUditor or County Recorder o� the counry where tl�e pmperty is located.
FrTirg Dates: i) Real Property: Must file during Ihe yrear lor which Ne deduclion is sought
2) AM6de / ManuFactured Homes not essessed as Real Property: Must fiie dunrg Me hvelve (72) maiNs
before March 31 0/ each year the ded�clion is sought.
See reversa side !or addi�onaf instrucUons arM qualifications.
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,�,a�orre�omvemi�w "�
M.B�N 1. prmlrt Year �
H ro. what k his ! hu exad share of infsest?
N name m recwd'e 6ftumt Nan ihat d appOrant,
Nartre ol rtartgagee ar rontrarl
twl0er of mortgage
AECress of assignee (num0er erM streeG �y, slete. aM
DDes e�ipN orm prapelty in airy oUer
�,^y � i^d�' r-� .,__ n .,_
amount oE
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�rrC9d��uditor
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Counry Remrder
GIBSON COUNTY AUDITOR
mn Remd numhc Pa7e rwmbc
l�- 030 _Uoo. �i3 _ �a� o?o,o a�v�
:/ Contraa'ude6te0ness unpaiE as W MoRga9e I Cantrac[ i`WebteArresa unpaid as d U Na eOW�t Ifx sde
artant yrar dete of app�tian s�J� /�y,�� legal or eputtaWe ownM
�/ (J �.,l�J ❑ Yes ❑ No
I/ ownaO with somew�e other fhan sP�e. Nd'�fe wtrh wMm
Debw. Is Me propeM1y in 9�e+�: �nualy Assessed
❑ Real Property ❑ MnuaOy 0.55essed
s�te, aM ZIP code)
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I/ We certify urWer the penalry of perjury that the above aM (oregoing infamation is true and cortecl and that the applirant is a resident ot I�iana aM
owner I mntract buyer of Ne atoremertboned properry on date appiicaCOn is filed.
� Signatue (o me) Date (rtoritli daY. Yge�)
T .� /7 /q
/` Fuo'"( ��da �nvrUneeramsr�cory,�ia«! IP�r�I HY 7767�
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agwn aw,o�a oy amr «ea,tea aowe. or am�,er w M �c s�.�-�z-0.�
ACd25s ot aulMrtred penon (num6er aM sfree4 �: ��, and ZIP code)
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