HomeMy WebLinkAboutMortgage_Lintzenich"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
.__ .• FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R77 /6-09)
�' ,,,. ° PresaibeE �y DePartmeN of Laml GovemmeM Firenca
I
�srRUCnoNS:
o be fJed in person or by mail with the CounryAuditw w Counry Recorder o7 the county where the pioperty is bcated.D C
Fdifg Dates: 7) Real Pmperty: Must file durirg the }rear fo� which the deduclion is sought C
2J Mobde / Manufactu2d Homes rrot assessed as Real Property Must file dunng the tweHe (72) monNs
before Marclr 37 of each year the Ceduction is sought C.'
See reverse side tor addHional instnictions arM qualificateons.
appfi� nt(o,�buye�see �ctionsonreverseside) �p , � •- ` 7 GIBSON
�T �� _
(/ �.(iYL�(/1 /✓LC.G/`-�
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1
t��
Y�
If no, whal is
AuditOr
Remrder
Ke�7man0er / legal Oe44ip4on 0 Recwd number Page numCrl
, a!v-�8- 8-�00_oo�(sa�-n� ►l 30
W Abrtc�a9e / Contraa inde6ted�s unpaitl as N Mortgage I ConttaR "vi0e0tedness unpai0 as d Is Me applcant the sde
Mamh 1, airtent yrar date af appfi�tion legal w epuRaNe owne(1
��%� nnn nY� n No
�f name m remrd 5 SAferen� Nan Nat of appGant. indinte Eebw
Name ot mongagee or mntraM seller �
A�tl255 N rtnrtgagee n contrad se➢er �numbr� anC slree4 �y. sfate, arN ZIP rode)
Name o( asdgnee w othrJ Owner w hdder of mMgage
AEdress of assynee (numDer and stree4 GN• ��e. and ZIP cotle)
Oces appficam ovm pmperty in any oNer I If yes. what m�nry?
counry in Intliana?
❑ Yes ❑ No
amount
20 _ � 20
I/ We certify under ihe penalry M pe�ury that
owner / conVad buyer of ihe aforementioned
SigreNre (awneYS MI nami�l'_� n
9ieet.
Person auNa¢ed by GWY execu;etl
20 � 20
Whai Ta�or
Is the property in questian: MnueAy Pssrsud
❑ Real Pmperty Q Armually Assessed
Moble Hpne (IC 67.
�U! ZE NST.IJ � S 1��Y�a� (,
J EN U.-��'%C L
► � - 5S,3o
20 � 20 � 20
and foregoing infortnation is true and mrtect ard fhat the applinnt is a resident of IMiana arW
n date application is fited.
p Dy IC Gl.
Pdtlress ot author¢eE pnson (numDer aiM street. ary, sfafe.
Dafe (rtront�, daY Y�/)