HomeMy WebLinkAboutMortgage_Mellor��•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
,,, . FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R8l 2-07)
��� Resaibetl by Depanment of Local Govemment Finance
INSTRUCTIONS:
To be lled in person or by mail with the Counfy Auditor o! the county where the properfy is located. � i
Filing Dates: 7) Real Property: Durrng the 12 months before June if o/the year the deduc6on is �to be eNective. �
2) Mobile Homes assessed under IC 6-iJ-7: Behveen January 75 and Maich 2 0/ fhe year the deduc6o/(is 7�e� '.
See reverse side 1or addi6onal insWCtions arrd qualificafions. GIBSON COUNTY AUDITOR
I Anoliranl fo mntrad 6wer - seaTecfrietiins reverse sdll � n A fi _. I
drip� Key number I legal descnption ' �
a�e �(�-o�-1 �(-I�o -cna. �, i-o��
ralue of mal qoperty as oF Mardi 1, aurenl year Monga nvad irWebletlness unpaid as of March 1,
�acl
name on
i�inle below:
Name of mortgagee or coniracl seller �
Atlaress of rtartgagce or mnlrad seller (num6er aiW sheef, tity, stste.
Name of assignee w other owner or holder of mortgage
applicant own propeny in arry aner
y in Indiana?
❑ Yes ❑ No
Deduction approved in Ue amount of:
zo � zo _
�
s' na unryAudiinr
I I We cer6fy under t e enalty of
Indiana and owner o e aforemen
�ature (owner's7ull name) `
. n
Is �he applicant Ule sde legal w aquitaGe owneR
I❑Yes ❑ No
spouse, indicale wiih whom.
I
Is the property in quaslion:
❑ Real Pro�perty ❑ Mobile Home pC 67.
as- ij�8
4ate, arW ZIP mtle) , i
I( yes, whffi ca✓' Has this detluc�ion been requested on proparty
ac������� �aaR�„��
. `,C �O:•'' ._ � � ❑Yes ❑No
, c �� .••'' I
,, �:a , • 8,, i
,,c� . ' �p • •''' �. . �
,,. c��a �,�9 a$ �
1 — ZD 2� � 20 _
'\. Cwnty Oate (monN, day, yea�
— '\, � � �—��—�
ury that tlie above and foregoing intortnaUOn is We and correct and that ihe applipnts was I were a resident of
ned property on March 7, 20 I
� � Date (rtronfh, Eay, yea^
FZO residenl atlAres�of applicant (number and slreef. cdy. sfa(e. aM ZIP mde)
�O "1`� o� N�J-oo w pa+d r.�. ,`�N ��-i'
Person author¢etl by duty ezecuted Poaer of Ninmey w by IC 61.1-1 -.07
Address ot authoraed person (number and sfree[. crty. ste(e. and ZIP code)
oaie (monN. ear. reen