HomeMy WebLinkAboutMortgage_Wickert^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
___ FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fortn 43709 (R71 / 6-09)
�'` Presaibed 6y �eP��nt o1 Local Govemment Fifume
ur
File a
INSTRUCT70NS: F� fl� �:
To 6e lled in person or by mail wiN the CountyAuditof or Counry Recorder of the counry wheie the property is located.
Fil'mg Dates: i) Real Property: Must file during the year lor whiGr the deduction is sought. � U 2a 2�nry Auditor
2) Mo6ile / Manulacfuled Hortres nof assessed as Real Pruperty Musf file during the fwehre (12) monfhs I''I ,,
before March 31 0( each year the deduction is sought. �■ �ounty Recorder
G .
See reverse side for addifional insfrucfions antl qualificafions.
qp (ownerwcontracrbuya�-seeresnicnons reverse � e) s, � GIBSON COUNTY AUDITOR
T
Ta ' isbict Key num6er / legal descri0� Rewrd numher Pege numCu
-/�'-i3 - oa -000. a ��-o �
Assesed vahm d 2al ynperty az N M1brtgaBe / Cantraa 4Webtedness unpaid az of Mwtgage / Contra�Y intlehted paiE as d �s Ne epplicanl Ne sole
Ma�U 1. ament yrar Ma�ch 1. wrtent yeer date of aPP��+ legal or epuitade ame(.�
� Q� ❑ Yes ❑ No
If ro, what ¢ ha / trer eraG share of interest? H owneC wiN mmeone other tl�an spouse. iMkate wiM xirom
I('artre m Rcad a dMemnt Nan tnat o( app�can4 mdifate Debw: Is P�rtY in puestion: Mnua%ASSeiuO
�,Real Property ❑ ArmuaOy Assessed
MoGleFiome IC61.1-i
�3me af mort9a9ee a mnttari se0er
Address of nwt�agce ar cmtrxl srder (number end crty, state, aM LP oode)
p�yme a{ �iy�e¢ pr otlw wmet or halder ot mM9age
Atltlress oi a 9�(^�^�r eM stree4 �Y. ��, an0 LP cotle)
�- sE 3�3_li .aY.4c
Does appli�ant wn p�operry in any oUer If yes. what wunty7 VJhat Tadrg Distri[Y? Nas Ns dedudirn Oeen reQUeSteE on propelty
couHy in Ind"mna? ❑ Yes ❑ No for current yeaR ❑ Yes ❑ No
COUN7YAUDROR . _ _ --- — —_
Deaumon approved'c� Ihe amouni oF.
zo_ zo zo �o Dra�ti�ei- NO..�L�.�.......
sg�wre w nnw� �°"^ry r � 7 v —
� Cal'(1 \O . .....................
I I We certify under Ne penalry of ury that Ne a anG foregoing infortnatlon is tr � I�� jxj � a^d
owner / mntracl buyer of inentioned pro on date appiication is filed. �•ii.
� Sigre eYS m 1 � Date (rtnNh. day, yea�
�
Ful esident re�of acp rion (num0er SLaet. dty, slate, a�Z/P codg) � G
vs `�'�.r( -�h r rc. G
Person auttrofaeE Gy dury executetl Power of Anorney or by IC 61.1-12-0.7 Date (rtanN, day, yrea�
`Adtlmss of auCia'ved perewi (num6er aiMN stree4 ciN. sta(e, and Z!P cade) .