HomeMy WebLinkAboutMortgage_Moore (5)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,_ • FOR DEDUCTION FROM ASSESSED VALUATION
� Sta[e Fwm 43709 (R71 / 6-09)
S f p��yty p�, pe��nt of Loml Govemment Frerrx
File Mark
INSTRUCTIONS:
� �.
To be filed in person w 6y mail with the CountyAuditor or Counry Recorder of the county where the properry is located.
Filing Dates: i) Real Property: Must !le during the year (o� which the deducfion is sought. � Counry Auditor
2) Mobile /Manu(acfured Homes not assessed as Real Pmperty: Mus1 file danng the twelve (12) months ,/��!
6efore MarCh 31 of each year the deduclion is snught. wu'^YiFecorde�
V
See reverse side for addiUonal insmictions and qualifications. GIBSON COU NTY A
Apqirant (owner w contrdd buyer - see msMrliwss m reverse side) . . . ' (� . �
zd �raEC o mal propsty as o(
i. anttrt year
Key twm6erl�legal destription
9 - lal -
Mortpage / Contraa'udebtedness unpai0 as
Mard� 1, artPnt year
II rw. what is his / her exx2 shara of interast?
If �ume m Rcad is ddferent Itwn Nat of app�can4 mAic
ot mMgagee r con U s Iler
Addressofnnrtgag �rcontraGSeDer(numberaMsn
Name of assi�ee w ottm! ovmer or hdder of mortgage
AECress ot assignce (number eM streef, ary, sfete, arM
Does epplimu ovm poperty in any oNer
tounry m IMana?
❑ Yes o
Deductlon aVWO+� In ihe amount of.
eet, crty, state. eM ZIP rode)
ZlPCOde)
If yes. what muni)/1
20 � 20 _ � 2U _
N Counry AuEiwr
20
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Recad mimber Page
�mpa10 az of Is Ne appl'iranl tne sole
1ega�°�� rtawa ownen
�E4Nes ❑ No
someone other than spouse, utliCate Wttf wlwm -
yI�s Itqre,, �pr�o�paty m Vuestion: MnuaAY AssesSed
I��cr� RoPerlY ❑ ��„ ^ _ -'Sed
--' .. 6
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— �o. acQ9..... ..
_ Dra���er �j'.��.3 ..
Card `IO• •��•..�.cA'
Whatia � � (�� O� — -
.iY
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yea�
I I We certify under the penalty of perjury that Ne above aM foregoing infwmation is W e and corteU arW tha[ Ne appfinnt is a resident of Indiana aiM
owner / wntract buyer of Ne aforementioned property on date application is fiied.
ent d:
02 E
authofaed M du
sbre4
person (number arM sbee4 �: ��. and ZIP mde)
oa�e (mw,m. eay, rea.�