HomeMy WebLinkAboutMortgage_Williamson.�.�* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n owns ip
°�� FOR DEDUCTION FROM ASSESSED VALUATION
State Fam 43709 (Re / 207) M R 3 0 2009
��; `� Resaibed by Depahment of lacal Govemmenl Fi�nce
INSTRUCT/ONS:
To be filed in person oi bymail wdh the CountyAuditor o/the county where the piopertyis located. - GIBSON COUNTY AUD
Fding Dates: i) Real PmpeAy: Durrng the 12 months be/ae June 11 0/ fhe year the deduction is to be eflec6ve.
2J Mobde Homes assessed under IC 6-1.1-7: 8ehveen Januery 15 end March 2 0/ the yea� the deduc6on is to 6e eflecUve.
See 2verse side fw additional insWctions and qualifications. ,
App� (owne�ormntradbuyer-seQgs�nclionsmreverseside) n. � . . �
of real pqae�ly as of Marrh 1,
what is his I her �aG share of i'rierest?
name
- - 3 - .� �o -oo� a3 � - v a-� �-oc� y � S
rent yeer Mortpage / ConVad irWebledness unpaid as M Maich 1, Is Iha appGmnl the sde legal u equi�able wmeR
wrtent year /
❑Yes ❑ No
If ownetl with someone ather lhan spouse, indiwla wiN whom.
int, indiple below: Is �he praperty in questian:
❑ a�� aro�r, ❑ Mobile Hmie OC G7.
Name of rtwrtgagee or conUacl seller �
/�__—�
Address of mortgagce a mnirap sel ler (num6er end sireef, dty, stafe. and ZIP cnde)
Name ot assignee w dher axrier or hdder ot mortgage
�
,penr �� a�y an�
❑ Yes ❑ No
0
if yes, wnat c«,myt
zo _
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DI'atiti'CI' 11rQ.�✓t!'f,�..V. ��woa�r
wne� - �.
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Cal'd NO. ....
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wNTraun . • • . �
zo _ zo zo _ 20 _
I/ We certify under � penalty of perj�((y that the above and foregoing infortnation is We and correct and that Me appliwnts was / were a resident of
Indiana and owner of the afwemenGOned property on March 1, 20 _
I r�enl address of applitaM (num6ei end s�G,ee�f". cdy. sfafe. aM ZIP aoda)
(�i/3G �i/ S�c��jei'm !�' di.,gnSii.'��
Person aulhwizetl by duly execuled�ower of Allnmey or by IC 61.1-12-.07
Adtlress a( aulharaed persm (number aM sfreeL aty. stale. eM ZIP code)