HomeMy WebLinkAboutMortgage_Bales (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS To i Year
FOR DEDUCTION FROM ASSESSED VALUATION
� � • Sfata Form 43709 (R11 / 6-09)
� Presaibetl �y DeparimeM af Local Govemment Fnance
�INSTRUCTIONS: SEP �iIOI�y
LVIL
Form 0ed wiih:
b be filed in person or by mail wifh the CountyAuditor or Counry Recorder of the counry where the property is located. C. .f�
Fii"mg Dates: 7) Real Property Must file durirg the year /or which the deductlon is soughG I d\ VMy qud"rtor
2J Mobde / Manufactured Homes rrot assessed as Real Property: Must fi!e dunng Me twelve (12J months nY) Re
6e(ora March 31 o/each yearthe deduction is sought. GIBSON OUI�''! A OR�ef
See reverse side 7a addiUOna/ instrucGons arrd qualfications.
npp�rayr(u�nerq�naaaeuyer-spqrcsr�iim'onsan'e�€}se3'be) , . �% n
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/
�.c,T,:fR-Ti!�n
II no, what is his I her e�aU share ot intr�t?
nartre m
rtnrtgagce or mnVact seAer
— cici - c� �•. v o co - Uc�-
I Mortgape / ContraG IMe6tedness unpaW az U Mwigage I Conva
March 1. artent yeer date of aPpOption
Addrea o} rtiartgagee w contracc se0er (nrun6ereM stree; cdy, state, aM ZIP code)
Nama ot assiry�ee w oNa avmer or Irolder of mortgage
Addfass o( assgree
If owntd wiM mmeo� otlter ihan
�
Remrdnumber Pagesu�
T6�
Mednrss unpaitl as M Is ihe apPG�ant Ne sde
kgal w epuitaWe amM
❑ Yes ❑ No
spouse. Wimte with whom
is tM pmperty in question: Mnua�y AssesseE
� Rea� Rovenv ❑ lvmualN Assessed . . _
/ /� �
Dces appiiont own propMy �n any omer Ii yes. wliat munty? What Taurg �sInC4 Has Vis tleGUUion Eeen repuesteU m prt�peny
ra' ° "__ ',—, tarwmmtY�Y.+ � Yes ❑ No
- �q�ES ��+i ��v.,�z A
,'�C�UR� � COUNTYAUDITOR
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— � a—y���i zo zo zo zo_
sy ca��N oz�e t�mm. ear. r�d
I I W�sg�tiry under the penalry of perjury that Ne above and foregoing intortnaGon is We and cortect arM that Ne applinnt is a resident ot Indiana aM
o�er� odntract buyer of the aforemer�eA property on date applicatlon is fileC.
Sipnahl� o�efs (ptl njine) /) _ �1 Date (m,qnth, day, yeer)
Psson auitw�aed
o( authoraed person (number and stree; dry, stdle, and LP code)