HomeMy WebLinkAboutMortgage_Moore (3)'.a °°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
. � � ' SYate Fam 43709 (RB / 2-07) � �.
�6 w,� 1 Presamed by DePartmenl of l.o�'al Govemmenl Firance �
INSTRUCTIONS: F CDe Z'��` 2009
To be filed in person or by mad wrth fhe CourdyAud'rtor o7 the courrty where fhe property is bcated.
Fding Dates: 7J Real Property: Dunng Ure 72 rtanMs before June il o/ the year tfre deduction is to be e/fective. �
2) Mo6iie Hartes assessed wWer IC 67.1-7: Befween January 75 and Ma�ch 2 of the year the deduction is to �_�
See ieverse side fa addi6onal insWcbons ard qualfications. �
GIBSON COUN7Y AUDITOR
Applicanl (owner or mnttatl buyer - see �6piclrms or� rererse sde) . )
Taurg DisUiG Kay number / legal desuiption
a� -i� - oi-�oy- o00
w�a ��e of a� popeny as a n��cn i, a„em y�r raonyaye i co�o-aa ��dewedness
, i�nte belmr.
• , L
� AdOress of mort9a9ee or oonVa�t seller (number aM
� Name of assgnee a ather owner a
� '��
ovm poperty in any aiher
a?
❑Yes ❑ No
� Deduction �p�oved in �he amaunt
� • _��
I/ We certiry un�r the penalty of
�ana and owner oi the aforeme
e (owners hdi name)
siate. anOZlPcode)
If yes, whal caunty? Whal T�
couNlrnuom
20 20 _
CWrrty
ReCON number
ss-oa�
as of March 1, �s Ihe appfi�anl ihe sd IE
wwiThh sorneane olher than spouse.
Page numbel
❑Yes ❑ No
Is ihe properly in queslian:
❑ Reai PmpeAy ❑ Mobile tlane pC G1.1-7)
�O•�•��'�� � �
D t���' Ci" 1 No
� —
CaCd ��• ....... ............. —
20_ � 20_
�Y. Y��
U�a� �he above and foregoing infwmaUOn is hve and correcl and Uiat the appGcants was / were a resident of
property on March 1. 2b � •
Date (month, tlay, yea�
`esiden� add�ss of applifant (nwnber and sLee1 tity. sta[e, and ZlP mde)
9 ff rU a•f s.u�.# 4�.��.:a.cve�'-Y y�t
an au�qrizetl bY duy esewle0 Power at lLLtomey or by IC 67.1-12-.07
� � Address of aulhor¢ed pmsan (num6er aM s4ee(, aty, sfafe.
Date (month, day, yea�
1 !