HomeMy WebLinkAboutMortgage_FrederickSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS vear y
ry � � �
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
• • Stata Fwm 43709 (R11 / 609)
�' � P2svibed by DeparimeM W Local Govemment Fuance
wsrRUCnoNS: MAR 2 8 g���
To 6e filed in person or by mail with the CountyAuditor or Counry Recorder of the county wliere the property is loc�tc� Fortn fled v.im:
Fding Dates: 1) Real Pmperty.' Must fila durng the year hr which the detluction is sough[ Counry Auditor
2) Mobde /Manufectu�ed Homes not assessed as Real Pmperty: Must Ae during the NmNe (12) months
6efore March 31 o(each year Ne deducfion is saght. GIBSON COUN y �O1nry Recorder
See reverse side Por additional instructbns end quali�cations.
Aoo5rant(o�armnbaa(buver-see�+sesidell .n � _.. _ � �
o[b' I l'V I" YCJ.7'v
Assessed ralue d real p�openy aa ol
Ma�U t, artart ym
1
R m. what Ls his / her erafl shara of i
If rame af 2mN is ?Atuent ihan fha
Name ot mat�a9ea or mntract seller
appOCanf, mtlicate Gelow
mntrad se�er (mmbalaMSIIee4 uN,
Name o1 assignee Or oNU mmel or hoWer oi rtqrtgage
ACdress of assignee (nurtiberend sheet �N: sfete, anc
Does epd�nt am WoD�Y in any ocher
munry m InEana? ❑ Y2s ❑ No
Drdumon aoorovad In tlre artaunt of.
20
Si9�4�re
"vMeMedness �mpa'si
Eate
h IAe epykant tlie sole
�gal or equRade ovmeYt
❑ Yes ❑ No
H awned wiN someone aUrer Ihan spo�ae. iridifate wah whan
(� y�s r� r,e�e�
n �r��iQ��4W� �+
' �
- �D��-�8/
20 I . � [U _ I 20 _
Is tlre property in puestim: MnuaDylvssesse0
❑ Real Roperty ❑ Mnually Assessed
�� � ❑ Yes ❑ No
20 20 _
Date (monM, daY. Y��)
I/ We fy under the penalry of perjury Nffi Ne above arM foregoing infortnation is W e and cortect arW Mat Me applipnt is a resident of IMiana aM
wm�ntract buyer of Ne aforementioned property on date application is filed.
lownefs h+0 name) Date (monfh. daY. Y��)
(number antl stree4 mY• �te.
Wnmed Ay dWy ezeW ttW Power of AlmmeY or py IG 61.1-12-0.]
ot author¢etl persrn (numberarM sIIee( tlty. sfa(e, aM ZIP ccde)