HomeMy WebLinkAboutMortgage_Sandefur.� °^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou s' ear
�._. _. FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (R8 / 2-07)
�� ���� r Pr¢srnbetl by Departmenl of Local Govemment Finance
A� rAanc 2008
INSTRUCTIONS:
To 6e filed in person or by maD wrfh the CountyAuditor o! fhe county where fhe pmperty is lorated.
Fd'mg Dates: 7) Real Proper(y.' Dunng the 72 months 6e/ore June 11 of the year the deducGOn is to be eflecGve. ,Q�
2J Mobiie Homes assessed under IC 6-1.1-7: Befween January 75 and March 2 0/ the yeai the deduc6on is to be flec it� Q'
SeereversesirJ�7waddi6onalinsWctions �qualifications. � / GIBSONCOUNTYAUDITOR
J
rApplicam ( r or.mnjraC 6uye� - see re " on reverse,side) n
ralue oi real poperty as
is his / het e:acl
���� ,� d�ji0/ oa0. /�f%-O 1a
1, curreM ya3r Mwigage / Contract indebtedness unpaid as oi March 1,
ninentyear ,4 �- �`
It reme on recwd is EiRerent ihan Ihal of applipnt, indi�le below:
Name of mortgagee or coNrdcl seller
Address of mortgagee a mnlraG seller (n�mbu arM 9i
Name af assignee or Wier awner w hdder of matga{�e
9afe, arW
ss of assignee (number and sheet, city, sfafe, aritl ZIP aode)
applicant own praperry in arty olha If yes, what counry?
y in Inda�1
❑Yes ❑ No
clion appmved in Ihe amount of:
pQ� p�� p—
wrtieone
Rermd
Is �he appFCanl lhe sde legal w equitade ovme(1
❑ Yes ❑ No
Ihari spouse. �cate vri�h whom.
Is ihe propeM in Question:
❑ Real Pmcertv ❑ Mobile Home OC Et.
KESi u A sAao� Fu rt —
„�,T� SAka N � �
do
COUNTY AUDITOR
20 20
Camry
V /— W��J
20
�
I I We certify under the penalry of perjury that the above and finegoing infwmation is we and corted and tha[ the applicanis was / were a residenl of
Indiana and owner of the aforementioned property on March 1, 20
Signature (mvnnls /ull name)
Date (month. day, yea�
���idenl address ot applicarri (num6er and sl6eet crty, stale. aM ZIP m
�i 2u3 �J �Sn� �� St P� �eh�v ��, 5..1
Person auUwrized by duly exeniled Paver of Atinmey w by IC 61.1-12-.07
Addrrss of a Wur¢ed prlsan (number arrd s4eeG aty. sfata, aM LP mde)
Dale (monfh. daY. Y�A