HomeMy WebLinkAboutMortgage_Klem_^�� STATEMENT OF MORTCaAGE OR CONTRACT INDEB��E� Township Year
: FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (Ri t/ 6-09)
� s PresaibeG 7y DeOartmeM ol Loml Govemment Fi�rce
� DEC 3 0 2011 File Mark
�srRUCnoNS:
Fortn hled with:
TO be filed in person or by mail with Ihe Counry Auditor or Counry Recorder o/ Ihe county whe2 fhe pm"
Fil'mg Dates: 7) Real PropeRy: Must file durirg the year for which the deduclion is soughL c\ Coun Auditor
2) Mobde / Manufactured Homes not auessed as Real Properly Must h7e dunrrg the twelve (72) monR+$ h
6eforaMarch3loleacAyearthedeductionissoughL GIBSONCOUNTYAUUITOR � CounryRecorder
See reverse side (or addifional insnuctions arM qualifications.
� o rorcmtra`� r-see�e�� mreversesde n
�( '(�ni n iC °l- � Jn n-� im� i �!/O /»�l
F Key number / legal d l R¢wrtl number Page number
a �O-/ -�/•' O /
prapcty as W Mortqage / Contraa'udebte0�ress unpxid as d Mwigage / ContracY mdebtetlnnss �mpaC a d Is Ne appfi�nt the sde
Mart3i 1, n�rtem yrar date of aOP��� kga� a eWitade owne(.+
� 3'y (�0� ❑ Ye5 ❑ No
erafl share of interest? If owned wiih someone other �han spouse. iMipte wiih Mqm
if name on reco�d 5 diRerent Nan Nat ot appfrant. mEinte Eebw.
Name of imryagce or mnuact seller
Mdress of mwtgagee or mntraU seller (number aM sfreeR �y. sfate, and
„�..�.
(numDer and stree4 Wy. sta+e, arn t�r coae)
Does applitanl wm property in any oNer I If yes. whal munry?
munry in Intlana?
, ❑ Yes ❑ No
Is ihe property in QuesUon: MnuallyAssrssed
�Real PtoPeM Q MnualyAssessed
Mobile Hane (IC 6
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R�u�
"" �l-S�i431
� v�v
20 I zo I zo I 20 I zo I 2o I zo
year�
I I We cert'rfy uMer Ne penalty of perjury that the above and foregoing infwmalion is W e and cortect antl Nat Ne applipnt is a resident of Irdiana aM
owner I contracY buyer of Ne atoremerrtioned property on date application is filed.
n ox+iers Iu� renre) /� Date (monfi, day. yea�
�y dWY ezeaiteC Power dAttorney or by
Pddress of aulhoeved person (numberaM shre( crty, stare, antl
yea�