HomeMy WebLinkAboutMortgage_Reinbrecht"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS courc
_ � FOR DEDUCTION FROM ASSESSED VALUATION
:• Sfata Fwm 43709 (R11 / 6-09)
� � Preunbed by �ePa�nt af L�I Govemmenl Funnca
INSTRUCTIONS:
To 6e (led in person or by mail with !he Co�nty Audito� or Counry Rewrde� of Ne counry where Ne property is located.
Filing Dates: 1) Real Pmperty: Musf 6le dunrg the year lor which the deduction is wught.
2J Mo6de / Manulactured Homes rrot assessed as Real Pruperty Must file dunng fhe twelve (12J monfhs
before March 31 of each year the deduction is sought.
See reverse side /or addifiona/ insfructrons arrd qualifications. . n
' AGP��t Synier orayntrad buyer - see resmraons % r o � �/
– e //–
If rame on 2cnd a EiRerent Nan that of ap�OCant, rtMicate bebv!
rUme m mu[gayee a conaaa seuer I� �/
� / / �
AGtlmss of `mtgag� or mntrad seJler (num6er ar
Name ot assignee or oNe1 ovmer or holder W monc
Pddress ol assignx (number antl atreet, rdy, sfae,
Oces epplimnt own property in any oNer
counry in In�iana?
❑ Yes ❑ No
uN.
If yes. whef count�/.�
�I �pry dito.
L (
ounty er
GIBSON
-c���3�-��i �a��� ����
iess unpaid as d Mongage I Contract'vWeb ess unpaid as d Is Ne epp6�ant the sde
date of appGtatim legal w eQUila6le ame%�
�Qd ❑ Yes ❑ No
If wmed v.iM someone other ihan spouse, Indimte wah wlmm
Is the praperty in 4�e"�: �nually AssrsSM
❑ Real aroaenr ❑ �^�N �
What Tari� DisUict7 Has Nis deEUdan Oeen reQUestea m proprlty
mrwrtemreaYt ----^----'�–
___.___________ V
Deduction approved In Ne amoum of: � ',,�r1�
DI':11yC1" ��........ `!,1..
2o zo zo 20
Card \'O. ...:??.I.� �.........
SgnaMe W Cam�Y /uWitw Couny �j I U (�1 q� V'"–
�
I/ We certify uMer �he penalry of perjury that Ne above and (nregoing informalion is We and correcc and that Ne applipnt is a resident of Irdiana and
owner / contracl buyer of ihe afwemen�oned property an da[e application is filed.
sivraw.e �o»,iers rw rernel • _ oate (rrmm, dar. yea�
FWI resiCenc addr¢ss olkppGfanl (num and stree4 aty, state, aM ZIP ootle)
� 4 W� ol D�rin�P�tou�Ra�-� t�J y
Puson auNorized by duty exewted Power o( AttomeY a M IC—� 6�7
Mdress W aut�arrzed person (number ark saze4 �Y. ��e, arM LP mtle)
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