HomeMy WebLinkAboutMortgage_Baughn^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
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FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / fiW) -
�` � f Presaibed by Departmenl of Lacal Govemment Frence .
NSTRUCTIONS:
Ai�� � �{1'IP�,�':
To be !(ed in person or 6y maif vnN [he CountyAUditor or County Recorder of the counry wltere the property is loca
Fifig Dates: i) Real Property: M�st file dunrrg the year for which Na deduclion is soughL � Counry Auditor
2) Mobde / Manufactured Homes rat assessed as Real Properly: Musf file dunng the hveNe (12) rr�ant�rs
6efore March 31 0! each year the deducfion is sayhG Counry Remrder
Sea reverse side !or additronal instmctions and qualifirations. G�BSON COUNTY A I m irn �
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Ta�(g ��s�
�t,�-[n�-a
A� rdue d
Ma'di 1, ame�l `�
II ro. what is his!
If �me on rem�d
{voperty as ot
ol intemst?
�/1�/ L �
/legal desaip' Record numbu Pege numbel
' - �- �O - 000. /S�f_D,2� /(oL7
M�r�p�ge/ ContraG indrbtedrress unpaid as of MMgage I Cartvaa i�eMedriess unpaid as W Is Ne eppGOnt the sole
Mart�h 1, curtent year date o( aVP�Uan Iegal a eW itaWe ownd/
SD D O D ❑ Y� ❑ No
�r awrrea wim mmea�re aher than spaae, i�akate witn winm
Name of rtnrt9aBee a contraG seuer S
MCress of mort9a9ce w mntrac� se0er (numbrl end sb
Name oT assi9nee w aMer owner or holder ot mort9age
Address qL�isvynce (nu �: �: �te, and
epplimnl am prope�ry in any omer
y in InCiana? ❑ Y� ❑ No
¢rim appmved in Vre amount of:
20_ N1_
:e4 ctty, sfate,
7lIP tode) /J
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���.�� W
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I I We certify uMer the penalry of perjutfi that the
owner I contrad buyer of the afaementioned pro
couNrraunR�
perty in Question: Mnualty Assessed
Roaenv �?nru,a�.N.^ssess�
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A�!� S �,�J
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20 _ -
Counry Da�e �...
e arW foregoing infortnalion is We and mrteU arW thzt the applipnt is a resident of Ifxfiana and
on date appliption is filed.
Date (rt�tlt. daY. Yae�)
F rrsiEent adtlress of appG �ulnl (nu�GeranC sbeet, ciry, sfata, aM ZIP cotle)
aos IUor�k tyl; �l Sf OwanSvi ll�e -�l�/
Prlwn auttro�aed by tluy ezecuted Power af Attomey w by �C G7.7-12-0.7
Pddress of auNw'¢Ed De�^ (numbB�arM strcei ctiy, sbfe, arW ZIP cade)
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