HomeMy WebLinkAboutMortgage_Dickenson"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS i Year
:Y-'..
; FOR DEDUCTtON FROM ASSESSED VALUATION
Sfate Fortn 43709 (R71 / 6-09)
,' � PresaibcN by Department of Loral Govemmenl Frence
��� File Mark
�srRUCno,vs: FEB 2
am ea wnn:
!0 6e filed in person or 6y mai! wdh the County Auditor or Coun y Recorder o7 the county where the property is located.
Filirg Dates: 7) Real Pmperty Must file dunrg the yearlor which the deducfion is soughG C.�. County Auditor
2) Mo6ile / Manufactured Homes not assessed as Real Pmper(y.� Must file dunng the nvelve (72) months
before March 31 of each year the deducfion is sought. ounry Recorder
SeereversesidetoradditimnalinstrucUOnsandqualficatbns. GIBSONCOU'T �
;ey number / legal dasaiptirn
a �-17-0 � -�o�
.���a � �r � ww�i � or
MatM 1. avrent year
ofinterest?
Name oi rtqrtc�agee a
Recotd number � Page numCet
Mortgage / Contraa'vWebtedness unpaid az of Mortgage I ConVaa indebiedfress unpaid a d Is Ne appfrant Me sde
March 1, artent year \ Date of appGtation 1e9a1 or equilaWe ovmeY!
��p � (pOCI ❑ Yes ❑ No
� tf owned wiN wmeorre other than sGOUSe. iMicate w�h whom
��
Address of mort9agee w cmtract seDer (nurtiber aM slreeS �+ry, sfa+e, aM ZIP code)
Name of assignee w oMer awner or hdder of mortgage
ndar�s
stree[ dry. s/afe,
�es applit2nt own propeM1y in any
counry in Indiana?
❑ Yes
No
If yes. whaf munly.�
Ne G�oPertY in 9ue5GOn: Mnua�Y Asse55ed
�Real P'nPertY ❑ MnualyAssessed
Mobile Hane !IG G
Dra�i�er 1iO... V�V'�.
Card i��o. ...ay,�x
IlSJ �J � l.lJ W n ❑ No
COUNTY AUDITOR
DeducGan app�wed in the amount of:
20 20 20 20 20 20 20
5igrature of Counry Autlitw Counry Date (montl�. day, Yaa�
I/ We certify under the penalry of perjury that the above anE foregoing information is We and cortec[ arW tha[ the applinnt is a residerrt of Indiana aM
owner / ntract buyer of �he aforemerrtoned property on date applicatlon is filed.
Sigrian efs !WI ram^e)l Date (month, day, y+ea�
V
Ful fesident addres of applirant (number antl streef, ciry, state, and ZIP mde)
g3�$ S s Uw �, 4 `](al�� PU ( �
Person autlw�¢etl by Euty executed Power of Attorney or by IC 61.1-12-0.7 oate (monm, day, ysa�
Address of auCior¢ed per.^,on (number and sbeeG dty, state. aM ZIP cotle) _