HomeMy WebLinkAboutMortgage_Yockey^�n �TATEMENT OF MORTGAGE OR
� FOR DEDUCTION FROM ASSES�
�.=— . .
Sfata Fortn 43709 (R71 / 6-09)
�,,,� f PresaiEetl by DepartmeM ot L.oml Govemment F�ana
wsraucnoNS: JUL 12 2011
To be �led in person w by mail wifh the Co�nryAUditor w Counry Recorder o/ the �L� ropelty is located.
Fil"mg Dates: 1) Real Pioperty: Must file during Ute year for which fhe deduction is sought.
2) Mobde /ManuFactured Homes rrot assessed as Real Properly Must fi!e dunrg e (72) months
before March 37 oleach yearthe deduction is souqht GIBSON COUNTY AUDITOR
See reverse sde (or addifional instructions arrd qualifrcalions.
I Anofrant (ownaroroonvad - see msmrJbns m rere� ' _ __ M _ ..
�wmCer / legal des�d7 /� I� I`,�� f O'
(/ `��
Mortg�ge / Contraq Udebtedness unpaid as o(
March t, arter�f ye� � � �
� tt ro. wha� Is his / her exact
IXI
Name of rtnrtgagee or mntrarl se0er e
�
Addtess oi mortga9ce or oontraa seAer (nwn6er aM stree4 ury.
Name ol assignee w rnher owner or hdder of mortgage
AACress o( a:signee (num6ei arM stree4 �Y. slale. and Z/P
Dces appticarrt wm pfoperty in any other If ye
counry in In�iana?
❑ Yes ❑ No
:za
LP cade)
File Mark
F�„m
County Auditor
❑ Caunty Recorder
" U� -IJCX/ (�UU J
Igag ect indeMednnss unpaid as M is Ne applicant Ne sole
: of application legal w epuitable ovme(.�
❑ Yes ❑ No
someone dher Uian spouse, ind'wate whh whom
IS IM V�PQrtY Ifl QuCSW(1: MMIB%A5565E4
❑ Real RoP�A' 0 /+�^�N �
: deduOion been re9ursteE m V��Y
D ��u3 .��� ❑ Y� ❑ �
ra��er \0... . .......... —
amourvoF. Card \i�. .... ���.�.....
zo zo � /5.J`OU;CSu zo
�
�\ �\ J / ' 1 VI �.I `-14/' I / �-+�� `�VL I Couob��y }�f /� �-„� — � I Date (rtpn/h. AaY, Y�d
ll 7J' d/ 1 ,( \
i\R..ALIo /
I I We certify under the penalry of p" ry Nat 1he abov an foregoing infortnalion is We and corted and that Ihe applinnt is a resident of I�iana antl
owner I contrad buyer of the aforementioned properry o d te application is filed.
�ul � aGtlr�s d ap9(i t umber slree�sbf� ZIP oode)
� Q^,�s� Il� rN 476 �s - 9z �(
Pason auNOmed Ey Ouly esecuted Power of AnvneY a bY IC 61.1-12-0.7 Date (rtimfh. Eay, yea�
Pdtlress of aWwf'ved person (numbera� street �ry. sb(e, antl LPmCe) _
�