HomeMy WebLinkAboutMortgage_Paridaen (3).a °'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43109 (RB / 2-07)
�� � Prasrnbed by DepaNnmt of Loral Govemmerrt Finance
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INSTRUCTIONS:
To be filed in person or 6y mad with the ComrtyAudi(or o( the county whera the property is bcated.
Fding Dates: i) Real Propes(y: Dunng the 12 monMs 6e(ore June 11 d the year the deduction is fo be eRecfive. � (►� Z o 09
2) MobAe Homes assessed'mder IC 61.1-7: Belween Janua 15 and March 2 o/the year tAe deducfion is o be etY e.
See reverse side for additior�l instructions aM quali(ICafions.
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GIBSON COUNTY AUDITOk G
i Key mimber a�+ ption � �� Remrd nurt�ey, Page number _�..�
—!'7 �� ��03.. OO.�a v7 - Q��x
�e of real paperty as d Marth 1, a+renl y�r ntrad irWeWedness unpaid as of March 7, Is Ihe appGCanl Ihe sde legal or equiUde o+rt�eR
�rt ao❑Yes �No
his / ha exaa share d interesl? If oancW with somea�e aher than spouse, indicale with whom.
cad is d'AfereM Ihan Ihffi of appiicant, i�mte beio.r. Is Ihe property in questim:
❑ Real Property ❑ Mobile Home (IC G7.7-7)
seller
Address d mor19a9ee or mntraa srJler (rwmber arr�9reet dry. s6te. amd
Name of assgnee ar alher amet or hdder af morigage
Address af asv9�e (�a/ � sGee1 city. 9sfe. and ZIP mde)
Does applicanl own property in arry dher If y
caunry in Indiana?
❑ Yes ❑ No
Deduction appmved in lhe amwnl of:
?p 20 20
y
DaUiwt7
20
Has Utis deduclian been requesled an paperty
for arrenl yraR
❑Yes ❑No
20 � 20 _
�Y.Y��
I/ We rtify u�er penalty of pe� at Uie�bove and foregoing infortnation is true and corted and thal the app6�anfs was 1 were a resident of
Indian and o er f ttie afwemen � proper[y on March 1, 20
iroUUe (owners me(j� y(—� � � }�/ � p % Date (rtxnfh. daY. Y��)
�V k%N--°�"'�I
address of apqicairt (nurnber and street dty, sfate. and LP mde)
�5�9 E. (J �11 L S�-. �or t— V31ro�-vt[.� � � �7 �i � �
rsan autharized by duy exawled Power oi N�ort�ey oi by IC 61.1-12-.07 ' Date (mon(h. day, yea^
Adtlress of auUqrized pe�son (number and sheet rdy, sFdfe, arM LP oode)