HomeMy WebLinkAboutMortgage_Simpson (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
+ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R11 / 6-09)
� PrcwibeE M DePartrtleM of Lad Govemrtrerit Firence
wsrnucnoNS: .
To be filed in person or by mail with fhe CountyAuditor or Counry Recort/e� o/ the county where the pmperty is located.
Fiiing Dates: 1) Real Pmperty: Must file dunng fhe year for which the deduclion is sought.
2J Mo6Be / Manufactured Homes nof assessed as Real P�perty Must fiie during the fweNe (72) months
before Ma�ch 37 0/ each yaar the deduction is sought.
See reverse side (or adtldional inStmcGons and qualifications. ,
�
Ii17lAuditor
Couniy Recordu
J GIBSON COUNTY AUDITOR
I a desaiD' Rem�d Page numbrl
- - -ODl• S
Aortyage / ContraG inde6tednes5 unpaid as o( Morcgage / Contrart'ude6tedne55 unpxN as of Is Ne epplkant Ihe sole
Aart�h 7,°/``�f \ date o( app�Cation legal or equitade owne(1
1 X� Cii' ] ❑ Yes ❑ No
at is Itis / her exac[ share of intrlest?
m record is SAfemnt Nan Nat of apP��. 6Nipte bebw.
Name W rtnrt9a9ee or mnbacl seller
Pddres d rtart9agee ar canbaq sc0er (number
Name oi assignee w oC�ni wmer w holdes of m
Adtlress ot auignee (number aiM s(ree4 mY. �
(NO�CIIY Ill d11Y W�1C!
n „�.
DeEudion apWOVeE ui Ne amoum
nT}: state. eM LP cade)
If ovmad wiin someone other Nan spouu, inafcate wm wnom
Is Ihe property in QueSSOn: Mnua9y A5se55e0
❑ Real Property ❑ Mnually AssesSed
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f�25I�16 dEdUCilOf1 bCC(1 fEQUgIE`d d1 QIDpPlIY
r« a�„ y�n n vPS ❑ no
20 _ 20 _ 20 _ 20 _ 20 20 _ 20 _
Sig�unue W Camb Auditw Caunry Data (month, daY. Y��
I I We certity under Ne penalry of perjury that the above and toregoing infomialion is true and corteU a`W ihat the applicant is a resident of Indiana arM
owner I mntracl buyer ot Ne afo2mentioned property on date aDWication is filed.
Person
ofaWro�rseOprlson (num0er
ry, s7afe.
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u0yIC1
sfate, ar
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Date (month. OaY,
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