HomeMy WebLinkAboutMortgage_Sisk (4).+F=•* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
r, ., FOR DEDUCTION FROM ASSESSED VALUATION �� �
� Slale Form 43709 (R8l 2-07)
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�� Resaibed by �epartment of Local Govemment Finance
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INSTRUCTIONS: �EC 1 2 ZOU� Ma*
To be filed in person or by mail wdh the CowtyAuditor o7the county whe/e the properfy is located. -
fding Dates: 1) Real Property: During the 12 months be/we June 77 07 the year the deduc6on is to be eAecfive
2) Mobiie Homes assessed under IC 64.7-7: Behveen January 15 and March 2 o(the year fhe de� grtis Wbe�ective.
See reverse side (a addifiona/ insWctions arM qualiFcations. Q �
� GIBSON COUMTY AUDITOR
IApqicant ( ei or mnfraQ bvyer - see resGidions reverse siCe) .
Ta�org isVicl Key n mber I legal desoi ' n Remitl number Page number
a6-i�- i9- ao-aoo• b'Y �- o�� 08 5/a8
Assessed oi real as of Mard� 1, amenl year Mortgaga I ConUad indeWedness unpaid as af March 1, Is Ihe appiifant �he sWe legal w equitable owne(1
artent year / � O
« ❑Yes ❑No
" ro, what is his / her �acl share of inleresl? If owned wil}� sart�eone dher than spouu, indiwte with whom.
I ir name on record is diRerent than Ihal of applicant, indipte beloa: Is the propeRy in question:
n ❑ Real Property ❑ Mobile Home (IC G1.1-7)
Name ot rtwrlgagee or conlaU seller
Adtlress ot mortga9ce w mnUact sell
Name of assignee w olher owirer oi 1
riry. sfafe. arM ZlPcode)
sLeef, city, stafe. arM ZIP mde)
Does applicanl own propeny in arry other
counry in Intliana?
❑Yes ❑ No
Deduction appmve0 in the amounl of:
20 C7r 20_
SignaWre of Counry Autlibr
`
If yes, whffi caunry7 What 7axing i•�
i .
f
COUNTYAUDITOR �.� �
20 2b 20
Counry
Dra�vcr NO.��::.5 / a�
Cal'd NO. ��
.....................
20
i.;��
I I We certily under the penalry of perjury Uiat ihe above and toregoing intortnadon is true and mrrect and ihat tlie appli�anfs was I were a resident of
Indiana and owner of the aforemenboned property on March 1, 20
ib?wre ( n rs hn� name) oa�e (monu,. der r��
sident �ddress of appicant (num6er end straet. cdy. state. ano ZIP wde)
ZBZ S. DG t7 S� r?. /o S ��.�,e.--5 ✓,Gtc, t N Gt?
i authorizetl by duty ezeculed Power of Attomey or by IC 61.1-12-.07
AdEress of aulhoraed persm (number aM sLeef, My, s(ffie. aM ZIP mAe)
o� ��m, eay,