HomeMy WebLinkAboutMortgage_Hyneman� O'�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709 (R71 / 6-09)
" yw 2 Prewibed by OepaM�ent of Local Govemment Ffance
te a
STRUCTIONS:
To be �led in person w by mail with the CounryAuditor or Counry Recorder of the county where !he property is located.
FiI'mg Dates: i) Real Property: Must file dunrg the year for which the deduction is soughf. nry Auditor
2) Mobr7e / Manufactured Homes rrot assessed as Real Property: Must fi/e dunng the twelve (72J months ���
before March 31 0/ each year the deduclion is sought. un Recorder
See reverse side Ior additronal instructions and qual�cations. G IBSON COUNTY AUDITOR
nod"inm (owner orSnead 61ver - p�s++�"l»ns M reverse side) /1 I �
T2�a Disbitt Key number I legal tlesrnpUon
a6 �s-ia - �oo - aoo� lb( - o� �
Acsessed value d 2a17opertY az ot Mort9a9e / Contracf'vdehtetlness unpaid as W
Ma�ch 1. aa�en[ Year Mafch 1, a�rtent Yrar � D
I( no. what's ha / her ezact sliare of interesl? . If wm�
If name on 2cort1 a dAlerent than Nat of aDP�nt, i�Mibte below.
Name of �rortga9ee w convacl
PAdress of mortga9ee or cmbact seAer (num6er arM stree4 �Y. �te,
Name of assignee or other owner or hdder of rtangage
Address o( assi9nee (number arM street d+}: sbte, a�
Ooes aPW�t ovm propeny in any oNer
munry in IMiana? � No
❑ Yes
1
i
D�ucGon app�oved'u� ihe amount of:
20 _ 20
Signature M Counry Auaiiw
wha[ count�/.+
rS��
indebtetlrress
spouse,
f is Ne eppfrcanl ihe sole
legal or equita6le ame!!
❑ Yes ❑ No
xlrom
Is Me P�nY in puestion: Mnually Assessed
❑ Real Propetty ❑ Mnually Psse.ssed
I 1M�at Tadig DistricY7 I Has Ihis deducTion 0[
for current yeaR
)UNTY AUDROR
20_ 20_ 20_
requesteE m 7�Y
❑ Yes ❑ No
oa� (rt,o�n,. ear,
20
1/ We cerUfy under ihe penalry of perjury that the above and (oregoing information is true and cortect arM that Ne applicanl is a resident of I'Wiana aM
owner I contract buyer of Ihe aforementioned property on date application is filed.
��uwre (ovmeYs lull name) � �r .. . ��f�/ Date (month. CaY. WaA
F`WI revEent aad�ss of ap�ant (numberantl slicet, tiry, state, arM ZIP oo�
Puson authoiaed Ey EWy executed Power o(Attomey or by IC 57.7-72-0.�
P4dress of author'rzed persa� (number arN sfreeG dry. state, anC ZIP code)