HomeMy WebLinkAboutMortgage_Wade--^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ : FOR DEDUCTION FROM ASSESSED VALUATION
• 51ate Fwm 43709 (R71 / 609)
�' f Presaibed by Department of Laal Gavemment Frence
INSTRUCTIONS: .
To 6e filed in person or 6y mail wiN fhe CountyAudiror or Counry Recorder of the county where the p�operry is located.
FrNrg Dates: 1) Real Pmperty: Must fife dunng fhe yaar hr which tha deduction is sought
2) Mo6ile / Manufactuled Homes rwt assessed as Real Property: Must fife during fhe hvelve (72J months
before March 37 of each year [he deduclion a sought.
See reverse side !or addifional inshuctions and qualifications.
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r '�,
' GIBSON COUNTY q
Tab 0¢trirt Key rum r/ legal desaiption Record number Page number
� - -o� -�o�-oa�.iqv-oaa- �009 �7
A�s�ssed vaNe d 2al poperty as N Mp�(p age/ Contraa intlehtetlness unpaid az of Mongage / Cmvari mEeWeCrress unpaid a o( Is Ne eppfi�nt Ihe sde
MaTh 7, armrt year Marc3� t, n�rtent date of aDP�wtan �eg21 or eQwtade rnme(.�
� (�� 3 �p ❑ Yes ❑ No
If ro, what a hs / her euG share of interest? If awned wiN someo� other Ihan spouse, iM'vate with whom
It name m 2md is tlirterent Nan tlwt of aDG�t. ��� ceb'�' Is ihe perty in 0�: �nua0y Assessed
Real PmPeM ❑ ?�!�!�!!�Y � .
N2m¢ W mortgagee ar cOntra�'2 seller ���
AGdress of rtartgagee or mntract seAer (num6er aM sveet �+ty, stale. aM ZIP code)
Name ol ass'gnea or oNer ownet or hdder W matgage
Pd02ss ot assignee (numbei and sheet �Y. s+ete, antl
Dces ePplifaM ovm pmperty in any olher
munry m Indiana?
❑ Yes ❑ No
DeducCOn app�oved in ihe amount ot
20 _ 2(1
Signature d CaunN Auditw
I/ We certity er the penalry of perju at
owner I ton cl buyer ot the a(oreme oned
SignaWR (owneh MI nartre)
couNTrnunn
DI':111'Ct' �°�. �.V �, / ''
.... �
] No
Card \`O. .. � 'Z. (°..�......
20 20 _ 20 _ 20 _ 20 _
Counry Date (mWA. daY. Y��
the above and (oregoing informalion is We and corteU aM that the applirant is a resident of Indiana aiM
property on date application is filed.
, oate (mavn, daY• Y�A
P611 resitle�6ddres5 of app�rant (num�jber antl sUeet �}; stafe, aiAZIP cotle)
�� � 2�.f 5T T� ��9�'�S/ �'(�
Person auUn�aetl Cy duy ezewted Povrer otAnaney or Dy IC 6L742-07
PdtlressotaWia�'veCperson (numDerarttlsfreef,ciry,uafe,andLPpode)
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