HomeMy WebLinkAboutMortgage_Abel+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun _ rownsnip vear
_. FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R11 / 609)
, f HesfiiDeE Oy DeP��M o1 Lod Gwemmerrt Filmnte
� File Mark
INSTRUCTIONS: J
To 6e filed in person or by mail wrth the CountyAUditor w Co�nry Remrde� of the county whe2 the poperry is bcated. �
Filing Dates: 1) Real Pmperty: Must file dunrg the yrear /or which the deduction is soughG � Counry Auditor
2) Abbde / Manufectured Homes not assessed es Real Property Must �ile dunng fhe fwefve (12J months y
before March 31 0/ eacA year Ne deduction is swghG !r�'�'�U Y R��
U
See reverse side�w addilionaf instrvctfons and qualificaGons. GIBSON
AooGram (ow� rt Ewer - see restrirt'ons m revwse sidel
� ��_,D�:�� 03- D00. 313-aa� � S
:ed ralue d rael poperty as d MorNag9e/ Contraa IrdeOtednesa unpaid as of Mortgage I Can� mcebtedrress unpak as d Is Me app9rant the sole
1. mm�t year Mam}� �a,r��� yPer � aate or ava��^ �� ��e ownen
5< i.�� ❑ No
m. what b ttis / her axact share o( u
name m rem�d "a tliRuenl Nan tha
artre of rtiortuaaea or mnttact se4er
ACdrnss d mortgags m m�traG sWu (number end saueL �:
rlame of assignea «wng wn,er a nwee, m mttt�
PGtlress of assignee (num0erad sbee4 �Y. state.
property in any oNer I tt y�v, whet muntyt
❑ Yes ❑ No
DeducCm approve0 In iha amount af.
�
Sig�aeae W CamH Nditur
It avmed vriM someme atl�er Can spouse. indrate wiih Miiom
Is the DroDe+h in Quesrim: nnrn�eM wssesutl
❑ Rea� ProPerlY ❑ MnuaOYAsse�ed
a�owr� Hare nc s
a)
Dra�ver ��•.o'�.Olb........
CardNO• ...o�,o,Z.9�••..•."'
� '1�.�✓.� _ a� ❑ No
�es
COUNT .
p- � �- � 20-
Counry
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I I We certify u�el the penalry of perjury that the above aM (o2going infortnation is W e and correct arW that the applirant is a resident of I�iana arW
owner I wntracl buyer of the afaementioned property on date appluabon is filed.
7 (oxr�hAname) -a Date(rtonN.daY.Y?e�
(/ / �i
�Y
of appfirant (number and sbeeS aN. �te,
w
person (numbe� aiM sbaeC �: sble, and ZIP code) .
(monN, daY Y��)