The URL can be used to link to this page

Home My WebLink AboutMortgage_Conklin^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS hip Year � : FOR DEDUCTION FROM ASSESSED VALUATION • -_ - :• State fortn 43709 (R71 / 6-09) �,w PresaibeE �y DepartrtreM ol Local Govemment Fuiamx wsrRUCnoNS: MAR 11 Zp��e Mark b 6e filed in person a by mail with the CouniyAuditor or Counry Recorder of Ne county where the pmperty is F� �� Fiing Dates: 1J Real Property M�st file dunrg fhe year lor which Ne deduction is sought. '' Counry Auditor 2) Mobde /Manufaclured Homes not essessed as Real Prz�peerfy Must file dunng fhe tweAre (12) rtwnfhs befae March 37 of each year the deduction is soirc�ht Cou^ry Remrdes GIBSON COUNT AU OR See 2verse side lor additionel instrucfions aiM qualifications. Aypfranl(owngfLYcw��buy�r-searesficG'ons�reeerseside)n /� ... � � �ri_�.. on RWN's 6felent tltan Mat of appOpnt "c�tluate Name of rtqtigagee w cnnttact seller Mdress of nwrtgagce or stree; cay, state, Name of assynee m omu wmer or ndou m morigage AEdress ot assignee (num0er arM streel, tiry, slate, an Ooes applimm oxn pmpury in any aher munry in Irqera? ❑ Ye5 ❑ No Deducaon app`oved'v� tt�e amount o� 20 2� __ Sig�hue W Co�mb A�WiNr � owned wiN wmeone aher Ihan spouse, ll��a�ti�e�- No.. aUII Ca1'd 1�°0. ..f.:-.'1� ............ �� D�. � Caurqy Rem�d numEer unPaid az of Is lei Wuate with whom rwmCel Yes LI No I5 Me P�PQrtY in Ouestion: MnuaDy Assessetl ❑ Real Roperty ❑ ArmUally Assessed Fias Ih5 tleCUCtion Oeen re9uesfe0 m p�opelty r« a�n y�n ❑ Yes ❑ NO � zo Date (nwnRi, daY. Y�� I/ We certify under Na penalTy o( perjury that the above and foregoing in(ormatlon is true and mrtect and Mat Ne applicant is a resident of IrMiana arW ovmer / contract buyer of Ne atorementioned property on date appliration is filed. rt¢n,re ta�s r,m name> /1 /J n • �(^�. ear. r��) � of ap(lirani (numDer antl street, z� SR 5� Ey duy ezecutetl Pawer of Atinne! ACtlress W aWio�'vetl persm (numner and sbee4 �y. sfa+a