HomeMy WebLinkAboutMortgage_Rickard.•°•r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
= FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (RB / 2-07)
�' �� Prescribed by Department W Loral Govemmmt Finance
,u.
File Mark ,
lNS7RUCTIONS: �
To be frled in person or by mad with the County Audifor o/ fhe county where the properfy is locafed. MAY � q�[ u�! �3
Fding Dates: 1 J Real Property: Dwing the tt months be(ore June 11 0/ the year the deduction is to be eBective.
2) Mobiie Homes assessed undei IC 6-7.1-7: Behveen January 15 and March 2 olthe year the deduc6on is to 6e eA�.
See reverse side for additional ins6UCtions a� quali(2afions. 'v�p� ,Q
n _ `� (/ .. Tno
rnppicam(owne�or�n6aebuye�-�resvic�ionsonra�rseside) , GIBSONCOUN7Y f+� I
�vhat is his I her exacl shara
If �ame on record is diRerenl Ihan
Key number,�%gal desoiption Record number Page mimber
-� -o�- o -000. �3-oa� �s 3a
Mardi i, qnent year Martgage / ContraG(j uMebtadness unpaid as of March 1, Is Ihe appfimnl �lre sde legal a equifahla wrtieR
wrt����� /�O - ❑Yes ❑No
� interesl? If ovmed wilh someme dfier Ihan spouse. indicate wi�h whom.
at of applicant, iMiote below: Is Ihe property in Question:
❑ Real PrOpeAy � Mobile Hmie (IC 61.1-7)
ar canlract seller
Address oF moM1gagee or mnlraG seller (numberaiM shcef. tity, state, aiM
Name of assignee w dher mvner a holder
Addrws of assignee
ovm poperty in any olher
ia?
❑Yes ❑ No
Deductbn apprwed in Ne amounl
20
Sigrewra
state, and ZIP mde)
Ifyes,whalcount}? WhaiTaxingDisVict',
COUNTYAUDROR
Zp � I 20 _ I 20 I 20
Counry
Drawer NOp���l1..:.:�. ./�
CaYd NO . ..............:..
.3� /��,,� . ....
`Y��.S� /O�J . O O
20
(rronlh, eaY.Y��
20
I/ We certify under fhe penalty of perjury that tlie above and (oregoing infortnaGon is true and corred and thal the applinnts was I were a resident of
Indiana and owner of ihe afwementioned property on March 1, 20
and sLeeL city. stale, a�M ZIP oode)
Power oF Attomey d by IC G7.
of euthor¢ed persan (numbei a� sheel, dty. slafa. aiM ZIP oode)
Date (mmN. tlay, yea�