HomeMy WebLinkAboutMortgage_Devine (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
:.--.
; POR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R77 / bO9)
S � Presmbed by �epartmenl af Lxal Govemment Fnance
INSTRUCTIONS:
To be filed in person w by mail wilh the CountyAUditor or Counry Recorder o/ the counry whe2 the pioperty is located.
Filing Dafes: 1� Real Properry: Must file dunrg fhe year /or which the deduction is sought.
2) Mo6de / Manulactured Homes rat assessed as Real PmpeRy: Must h7e dunng the �weNe (12J rtwnths
6efore March 31 of each year the deduction is sought.
See 2verse side for adddional instrucUOns and qualifrcairons.
_„�.,.,_
�����
�fa�U 1, CVrPJIt �
whal rs hi5 / her e�cl share of interestt
Ii name on remtl a QMemnt Nan Nat af appliont,'uMinte Eebw:
Nartre o( rtqrt�agee v mnuap seDer
C
Address of nqrtgagee a contraU seller (number and sdeef, cRy, sfate,
Name of assignee or other owner w holder ol mortgage
AAtlress of assignee (number end shee4 �y. slete, ar+d ZIP tode)
�-003 . aba-o►?
unpaid as W Mortgage I ConfralY mdebtetlness
date of appGCation
any dher � If yes. what munt�? � Whal Taong D'Wna?
spauu,
• M'� Co�i�RB�tnr
� o ecorder .
GIBSON COUNTY AUDITOR �
Remrti numEU Page numCr!
�mG� a of Is Me aGD�t Ne sale
kgal or eWitable owneR
❑ Yes ❑ No
Is the WuGenY in question: MnuaOy AssesSeE
] Rea� aroaertv ❑ ��N /��
reoea� rw� nc ��.�
Has Nis tleCUUim been reQUesteO m p(nputy
Far wnm� Y�R
❑ Yes ❑ NO
COUNTY AUDROR
( Deduclion approved'ui the amount of:
20 _ 20 _ 20 _ 20 20 20 24
Signature of Camry nWitor Counry Date (rtaivh. Cay. yea/)
I/ We cenify under Ihe penalty ot perjury Nat Ihe above and (oregoing infortnalion is true and corteci arW that Ne applirant is a resident of IMiana aM
owner / mntraU buyer of ihe aforemerrtioned pmperty on date application is filed.
I' nve wne/s fiM me) Date (rt�onfh. daY Yaa�
-s-�a
u ' ent aGdrass o appl"sant (number antl stree; riry, slate, ard ZIP mde)
4 6
Person autta'¢etl by duty executetl Power d AtlameY a q' IC G1.1-72-0.7 Date (monN. tlzy, yea�
Pddr�s of authn¢ed person (number aM sneet ary. slate, and LPmtle)
�" _'"—