HomeMy WebLinkAboutMortgage_Lienemann (3).? °'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION �� �
Slale Fortn 43709 (R812-07)
w,� 1 Presrnbed by Department of Local Goremmenl Finance
i Mark
�NSrnucnoNS: APR �. 9 2
To be filed in person or by mad wrfh tlie CountyAuditor o/ the courNy where the pioperfy is bcafed.
Fd'a�g Dates: 7) Real Property: Dunng the 12 months be(ae June 11 0/ fhe year the deduction is to be eRective. ,�"'
2) Mobile Homes assessed under lC 6-7.1-7: Belween January 15 and Marcfr 2 o/the year the deduc�jste 6�eaeypve.
See reverse side for additional insWctions arW qualifications. Q U
GIBSON COUNTY AUDITOR
see restricfims on rever�p side)
ot�a
`wmber
/ � (T !o — l - / � - (N - ci - U � v '-r
Asessed rahie of 2al poperty as af Mart�h 7. ctrreM ymr Morigage � Cuntrad indebtedness unpaid az oi March 1, Is Ihe appGfant Ihe sde legal n eq�ntahie owneR
ainentYear�O� `
�� es ❑ No
If ro, whal is ha I her exaq share af interest? If omied wiTh someone dher ihan spouse. iMicate wifh whom.
t� on record is d'fierent Ihan ihal of applicaM, indicate below: Is Ne propeM1y in questian:
eal Prqperty ❑ Mobile Home QC G7.7-7)
�' �f mortga9ee or canlracl seller
'�
Address of mortgagee a contraC seller (numbu aiM 9ree( tity. stafe. aiM ZIP code)
a ather owner w hdder of martga9e
Address ot assgrree (mm�ber arM sGeel,
Does applicanl own property in arry dher
couNy in Inda�?
❑ Yes ❑ No
Deduction appmve0 in the amount of:
If yes, whal counp?
r����� ' � �'0
COUNTYAUDROR
20 20
Counry
Has Ihis dedudim been reques�ed on praperry
tw arrent yea(1
❑Yes �No
20 20 _
Date (mmth. day, yea�
1/ We cerGfy under ihe penalty of perjury that Ne above and foregoing infortnation is true and mrtect and ihat the applicants xas / were a residenl of
Indiana and owner of ihe afwementionedproperty on March 7, 20 _ _
ZIP
Pason authwized byduy rxeaited Power oftLLtnmey a by IC G1.7-12-.07
'�(/ ���
av s of aWtnrized persa� (number and s6ee4 �'fi'. state, aM LP co0e)
Date (mmN, day, yea�
I L �1 U �
Date (mmfh, tlay. yea�