HomeMy WebLinkAboutMortgage_Elpers (11)� '�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Stale Form 43709 (R7716-09)
S,,,. Presaibed M �epartmen� of Local Govemment France
le
INSTRUCTIONS:
To be filed in person or 6y mail with the Counry Auditor or Counry RecoNer o/ the aounry where the properry is locat�{ F� �� �
Filirg Dates: 7J Real Pmperty: Must file durng the year fir which the deduclion is soughf. J�i N � � 2�unry Auditor
2) Mo6iie /Manufectured Homes rat assessed as Real Property Must 61e dunng the hveNe (72) marths
befwe March 37 oleach year the deduUion is saght. C� Counry Recorder
See reverse side lol addiLOnal inshuctions antl qualfications.
AppGcant (owner woontra�( buye�- see rcshictbns on revers� sitle)
GIBSON COUNTY AU
Tad�g Distr4Y // (/ Key rwmber / legal desaiP� Remnd numbPi Page numW
�� a� is-a�-�oo_oo�. o�d-oai �o r a�-3B
Assessed � o( real as of Mort�age / Contract indebtetlness unpaid as of Mortgage / ConuaU "v�Eebttdness unpaid as d I5 the appGant Na sok
MarU 1, qarent ym Martl� 7, a�rtent year Oate of agotip� Iegai or equitade v.meR
�G O� ❑Yes ❑No
,f ro. what's his! her e�U share of interest? If awned wiN wmeone otMr Ihan spouse. indicate v.iTh whom
If name m reco�d'S EilFerent ihan Nat ot aPPlitant. ifMiwte bebw: Is Me properry in Questiwr. MrwaM Assessed
❑ Rea� a�,�eny ❑ n�,nuaiyassessed
name ar nnnyagee or
ACd2ss o( mptgagee w conUap
awner w
AOEmss o�ssTgnee (rv�m^^• �^w •�•°°•
� N!J
Does apptinm ovm property in any olAer
cwory fo �ndiana?
❑ Yes
Kir�"v'�"'..� iC/�C_4-
Ser end stlee4 cey, slate, arid ZIP code)
mortgage
a..n ]ie..Hn1
� -.�-� i a
If yvs. whal muncJ�
I No
Dfa15'�1' �'�... `�,,,I.........
- aa3�
� L Card NO . .....................
VYhat Tadrg Distn
u>S, 6�0. �
COUNTYAUDROR
De�ucOm appoved in ihe amount of.
20 20 _ 20 20 _ 20 20 20
Signanne N Camry Audaor Caunry Date (Imvh. tlaY. Y��
c _ r.
I/ We certify uMer Ne penalry of perjury t the ahove a egoing infortnalion is We and corteU arW that Ne appli�ant is a resident of IrWiana aM
owner 1 contract buyer of the afaemeMioned p�operty on d e application is filed.
Sig (owrrer3lW ) Date (r�vuh. day. yea�
ull appGran (numDer antl sUeel. dty. state, and Z/P cotle)
�- �
� u.rt;.i
Persori autM�rsed Dy duly ezewt Power of Atlomey or by IC Gl. t-12-0.7 Date (mmN, day, yea�
Pdtlress ol auCwr'¢ed person (numGer arM street �y. sfa(e, antl LP cotle)