HomeMy WebLinkAboutMortgage_Johnson (18).""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R10 /11-08)
��.r � P'esaibed bY �rtrtient d local Go�ernmerd F'r�an� '
INSTRUCTIONS: de a
To be fded in person or by mad wifh fhe CouNyAudiMr d fhe county wfrere the poperty is IacateQ.
Fr7ing Dales: i) Real PiopeRy: Must fife durirrg fhe yea� lor which the deduction is saughG f1 �n�n
2) Mo6de / Manulectured Homas not assessad as Real Pmperty: �Must fiie tlun� the hrefve (12J months 6e(ore /�ei�3ypJ5ac.veBr
fhe deduction is sought.
See reverse
App6at�1(or
B ro. wha� a his I h�
If �me a1 rBmd'R
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Key numbar / lepal desaip .
�, l�-U — -
aga����
1. airteN Year
uitlicafe
-_T.'�J..,�
r oaiar ow�rer or Mlaar d mortBa7a
i(iwwmbor and sbocL �Y. sbb. xd LP m0o)
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20 I 20
GIBSON
unpaitl as d MWgape / Cantraq inEe6(ednass un{aid as d Is the appEfar� P�e sold
dafa of appfimtion legal a eQUimDle vme!!
� Yes ❑ Na
tl owned w&h someore dher Nan svwse. 'uNic�e wilh whmn
Is Ihe D�7aM in Cuaslion: Mnualy Aasessed
eal Property � MnuallyACSessetl
� � MoGle Fbrtie (IC 61.1-7
�AN��N, oAC.� (�.
�� —�301 C�
20 I 20 I 2(1
20
H
� No
I/ We cer0fy under Ihe penalty of perjury t�at the above and (oregdng uifortnation is We arW corred anC ihat the applicant is a resitlent of Indaru and
owner I conhaG Wyer of the aforementioned property on date aPPlimtion is fiied.
Mature (owrmfshID^�ne 1 _ . �% Date (mmlh. LaY.Y��)
� �Ia � � �, S,�-le �-�, �N h1.rZ k �a�, �'� � y � 6
Persm authaaeE by Euly azeaitaE Power o( Atlnmay v by IC &7.1-12-0.7
PdCress d aWhorized persan (nvn0or andsLee( oty, sfate. antl LP oode)