HomeMy WebLinkAboutMortgage_Osborne"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09)
,' y�. � Prvsaibetl by DeparlmeM o! LoCal GOVemmerR Finerce
File Mark
INSTRUCTIONS:
To 6e fi(ed in person w by mail wiM the CountyAud'ROr or Counry Recorder ot the counry where the property is located.
FiNng Dates: 7J Real Property: Must file dunrg Ne year for whicA the tleduction is sough[. � County Auditur
2) Mo6�7e / Manufacfured Hortms rat assessed as Real Property Must fi7e dunrn� Me nveAre (72J months /
6e(ore March 31 of each year the deduction is sught. N ���
See reverse side fivaddifional inshuctions and qualifications. GIBSON COUNTY V
(owxr mconlydU buNe+' me msfrcGw�s m re`erse s/e)
T' istrirt Key rvxn0a / legal desa'rytim Remrtl numEer Page rwmOri
� a-�7- _ o�!-000. o�i- o�� oio 3�c.t
AssesseC vWue Ureal V�Y as of �C9aBe / Cantra� irdehted� unP� as d Martgage / Contraa cMebtedness im7� es d Is Me aPP�� Ne sole
Mert�h t. a�mrt year Marr7� 1. wrtr.�rt tlate of aPP�tpn kgal or epuitade owne(/
❑ Yes ❑ No
ir no. �c �s ns � ne. uau snare o� �r�asca rc�a �u, � oare. w� �a,�. ma�a wm �
tt rwne m rcmd is 6ffumt tlun Nat o( aOP�C mEimne belmr. Is the property in GuesUU� Annia9y Asttssed
J�� �xro ❑ �N �
Mobde Hortie C 61.1-
Nama of rtnR9a9m «contrffi sNler
—_ _ _ _—
Pddreu d nnrtgxJce ar mntraU se0 (nembe� and svee4 �Y. 9a7e, ard LP codeJ ��' �
DI'1\1'CI' \'� ..............�.....
Name at assgnea or othel awntt w halder d mortgage
AdCress of assig�ce (numOU aM stree4 �: sbte, aM LP mae) C:1 I� U�� Q. � I�+' I
...............
Oors eppli�nt rn.n P�P�Y in any oMe1 tt Y�, what muntyt What Tapng Ds � �%) 1 L(•� v
counrymintlena? ❑ Yes C �
❑ No
COUNTYAUDROR
Deduaon approvad'ci ttre amount o!:
20 _ 20 20 _ 20 20 _ 20 _ N1 _
SignanrtedCo�mbAuditw � Counry Datafrtwith.CaY,Y��
I IWe certity under th nalty of perjury Nat N above aM foregoing infortnalion is We and cortect arW that ihe applinnt is a resident of IrWiana aM
owner I mntraa buyer of Ne aforementioned p rty on date application is filed.
Sig h fu9 neme� Data (monfh: daY. yee�
W'' adOmss of appl'xant (number and sLeef. dry, state. arM LP mtle)
�,.. S �.Irr ?N41(�(c� POBor�S�. ON�.h..,tlr J.N`�76
Puson autlwr¢ed by Cuh/ ezecutetl Power af Attort�ey w by IC G7.1-12-0.7 ua�e (m«rtn. dar, ree�
Pdtlress of aWwr'¢Ed person (numberaM sbeet �ifY, sfa(e. anE LP mtle) _