HomeMy WebLinkAboutMortgage_Estep (5)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
. �• State Fortn 43709 (R71/ fi-09)
` y„ 2 Presaihed by Department of LoW Govemment Finance
e a
STRUCTIONS:
To 6e filed in person or by mail with the CountyAUdifor or Counry Recorder o( fhe counry where the property is ocated.
Fdirg Dates: i) Real Pmperty: Must file during the year for which Ne deducfion is sought C� unry Auditnr
2) Mo6de /Manufactured Homes not assessed as Real Property: Must fiie dunng the tweNe (12) month� AR J^ ��unty Recorder
6efo�e March 37 of each year the deduction is sought.
See reverse side for additional instmctions and qualilcafions. C.�. n
App6ra o �ar�f� b see ie.wirlions m �)
�'CL/Q/ Gt, � (,L �S GIBSON COUNTY AUDITOR
p' �Key number / al E ' tion Recortl number Page numbu
. _ % � - 300 - aoo. � � a� � � i�s
rdWe o( 2a1 pop¢rty as of Mortpa ge / Contract indebtedness unpaid as of Mongage I ContraC inEebtedness unpaid as o( Is ihe appifant Ne sole
��� y� March 1, airtent year Eate of aDP�� %% ,1 legal w epuita6le ame(1
/ Q DUv ❑ Yes ❑ No
tt ro. what ¢ his / Mr emY share of interest? If owned wiM someorie oNU than spouse. I�icate wtth wlwm
If ranie on 2mrd is tliRerent Nan tha� o( aPplkant, 6�dicate helwr Is Cre P�PenY in Questim: MnuaM �sesse0
❑ Rea� Roaenv ❑ mm�,anr w�ssea
Modle Fimie IC 61.1 �
IJam¢ of rtitvtgagee « mntrarl seuer � /
//.Y- IC.l.vi-rCfL
Address of mortgagce or cmtracl se0er (number and sLee; ray ate, aM ZIP code)
Name ot assignee w oihr! ow�er or hdder W rtprtga9e
ACCress of assi9nee (number and slree4 ury. slete, aM ZIP code) ___
��._� "'\a.T�� i.-:iit�..i=._��.1.� ��..a......, —
Dces epplit2nt an�n pmperty in anY olher If yes. nfiat a ' Dee� re9uested °� 7�Y
munryinlnd'ana? ❑ Yes ❑ No T �. �io`I ❑ Yes ❑ No
Dl'814'Cl' ��...��... ...,.....
Deductim avw� m ihe amount of: 3 r I� '
Card NO . ............:. �.�=,.
zo_ zo_ zo . "� ,�C�j ��.� .... _ zo_
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sigrenne a Cmmb nwitw ��b . • . • . . � _� °'�. dar• ��
I I We certify undef Ne penalry of perjury that ihe above aM (oregoing infortnalion is We and cortect afM Nat Me applicant is a resident of Irdiana aM
owner I contract buyer ot the aforemenlioned properry on date appfication is filed.
m (o,mers hrAAn-am_e)
o-a� (morvn. dar, ree.�
_YV\
I �ddent aEd`e� of appGont (num6erarM sbee( dry, state, entl ZIP code)
34 S�x �l 5� C�c� '�c9 U�
Prnw� aufM¢ed Dy dWy executed Power alASlomeY or by IC G7.1-12-0.7 Date (rtanN. tlay, yae�
Atldress of auNu'ved De� (number and sbeet �ry. state, an0 ZIP oode) .