HomeMy WebLinkAboutMortgage_Whitehead." STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T n ip Ye
_, FOR DEDUCTION FROM ASSESSED VALUATION •
Stala Form 43709 (R70 /11-08)
`,.,. � Prasaibed by DepaNnant d Loral GovemmeM Finarce '
INSTRUCAONS: Rle Mafk
To be filed in person w 6y mail wiNr fhe CountyAuOitor d the county wlrera fhe propeAy is bcafed.
flling Dates: i) Real Property: Musf Poe during the yearlor whicA fhe deduction is saight.
2J Mo6de / ManutaGured Hort�es nof asses�d as Real Property Must file dunng tlie hveNe (12) mmttu befira M 31 a�$e �ye�
thededudionissought GIBSON COUNTY AU0170(7
See Ieverse sCe fur edd"dional insLuciiorts aM qualificalims
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7mvg Distrid Key numhar / legal des�ii�tio�
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AssesseE v�ue d'eal propeM as d Mortgage / Coniracl iM¢We
MaRl� 1. artrer� Y� Marrh 1. wrraM Year
Y ro. what is his / �er exacl share d imarast?
u fame m remre is e�eiem u�ar� um ot zao�v. iM'sam ce�oi.-
Name d moriGa9e6 ar mmaa se0er
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Card NO, ""'
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COUNTY AUDfTOR •
alm xavro.ed in me ar�wM or.
20 20 20 20 20
P
ituea d Courqy Autlita CnvVy
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�debtedness unpaid az d Is lhe appfaaN Iha sde
legal owiaR
Yes ❑ No
an spouse, iMCate wdh Wvn
e WuoeM m m+egim: nmuaN' Assessed
Rea1 PropeAy Q Mnualy AssessaC
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❑ Yes
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No
I 1 We ceAify under the penalry of perjury Mat the above and faregdng ui(ormation is true antl correct an0 �hat the appGrant is a resident o( Indiana aM
owner / mntraG buyer of Uie aforementbnetl property on date applimtion is filed.
nalura (o�+refs fiLl ) Date (rrmaN, tlay, ywx)
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