HomeMy WebLinkAboutMortgage_Bitter"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__,. FOR DEDUCTION FROM ASSESSED VALU�Qyr ��
� Slate Form 43709 (R11 / 6-09) �� 1
�' d Preuribed by Departmenl of Laral GovemrtreN Flrerce
�W File Mark
�STRUCTIONS: �[('� (�
TO be fiied in person or 6y mail wifh the CountyAuditor or County Recorder o/ Ihe coubty-wn� �e�YB�rty is bcated.
Filirg Dates: 1J Real Property: Must file dunng the year for which the deduction is saught. �-�r,;,�r,,�
2) Mo6i7e /Manufaaured Fbmes not assessed as Real Property Must QI¢. BuA� " V 12) monfhs
6e(ore March 37 a(each yearNe deduclion is sought.
SeereversesideforadditionalinstroclionsanUqualifications. • COUNTYAUDITOR
MP�n�(ownerormnvarl6vyer-see ra �verseside) . .. .
Fortn Ned wi .
Counry Auditor
❑ Counry Recorder
is' Key��i�;a°`�-�-�oo-r.oa.�s-oa� ��� � P�en� � C
1 ralue af mal �aaperty as of Mongage / Contraa irdebtedness unPaid az U Mortgage / Cantra� i�Mebted�rss unpaid a d Is Ihe aPP�t Ne sde
�� ��" �%b o� dale of aPP�� �� o Y� o
Iq. whBl IS hL5 / IIPf CY2f� Sh2f2 01111IP1¢5t?
If owretl wiM some�re dhu Ihan spouse. indifate wiN vApm
If name on recad is tlifterent ihan Nat of appGcant, hMilate bebv!
Name of rtwrtgagee or contrarl seller �
Maress W rmrtgagee u contraa se0er (num6er and shee4 uN, sfd:e. arN ZIP wde)
Name of �" �nee rn other owner or holder of martgage
Mdress of assgnee (numDeraid sVee4 �Y. slate, arM ZIP mCe)
Dces applitant am procenY in anY oNer It yes. �Mat muny? What Tap�g DistriC?
munry in Indana?
❑ Yes ❑ No
1 COUNTYAUDROR
zo I zo zo zo _ zo _
Signanrte ot Counh AuOiiw Counry
Is ihe property in 9uestion: MnuaM Assessed
❑ Real Property ❑ Mmually �
UI'8�ti'CC �'�.. �!:`�; �.I .
Card \'O. ....����
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c�rn. a�: r��l
I I We ce nd r ihe penalry of perjury that the above afW foregoing infortnalion is W e and cortect and tha[ Ne appli�ant is a resident of Irdiana aM
owner I uyer ot the afa�nr�nt e p perty on dpte applica0on is filed.
manve (o /s lu name) —T% Date (nmrh, day; yea�
esewted Porer d AttomeY w by IC G7.1-12-0.7
person (numbera� sheet cNy, sfate, antl
Nama of appfimnt
(Rp�M da4�' ����/ / I Mnamt M in0ebtedness
/ ��
2TGAGE OR CONTRACT INDEF
Nartre d mwtg29ee u oono-act se�er
ca,�y
2011
� c�
GIBSON COUNTY
yea�