HomeMy WebLinkAboutMortgage_Carson^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun'
� FOR DEDUCTION FROM ASSESSED VALUATION
~ State Fortn 43709 (R11 / 6-09)
��w � PresaiEM by DeP��b af Lami GovemmetLL Fiiwica
INSTRUCTIONS:
7o be filed in person or by mail wifh the CountyAudrtor or Counry Recorder o/ Ne counry wheie the property is located.
Fi!'mg Dates: 1) Real Pmperry: Must file dunng fhe year for wbich the deductlon is sought.
2J Mo6de /Manufactured Homes not assessed as Real Property Must fi7e during Ne hveHe (12J months
6efore March 37 of each year the deductlon is sought.
See reverse side for additional instrtictions and qualficatrons. '
JU�l ��P$1?�a�.
� � County Recorder
App6ran ror buyer-see mreversesde) GIBSONC v
OUNTY qUDITOR
ra o� �rn,�.i ia�w;a, 000. d D�i��O a�«a�e� ( r�e3 ���
f2cL � G- o�-a s- /ba - �
Asessed �ahie a( real qoperty as d Alortnage / Cantracl indebtedfress unpaid as ot . Mortgage / Cantrar2 bWebtetlness unpaef as of Is ihe app�r.ent Ihe sde
Macli 1. anart ymr Marrh 7, a�rten� Q date of appfit�ation legal w epuita6le ame(.�
�� /��� ❑Yes ❑No
11 no. what is his I her exac[ share ot interestt If axned with someorre aMr than spouse. iMkate wiih wMm
It �ame m mmrE is Eilfefmt ihan Nat al appGcanL 4dKate Eebw.
Nameotrtrortgageaorcontrap
I�I'�'J1.'�,.:i..�
Name of assignee w aher oxner or hdder o( mortgage
crty, sfafe, ard
naaress ot assgnce lnumoer am suee4 my. su�e. am ur coae7
Does epdimnt o+m property in any other If yes. w�ai
oounry in IMiara? �.. �..
�he amount ot
zo � zo � zo _
Is tl�e poperty in Queslion: MnuaOy Asws,^M
❑ Real a'oaeNV � ��N �
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�v�.d Rd��:�,;r�
^ � feduciiw� d
o[�� � ny�r.
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Caunry
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Date (rtanM, daY, Yea�)
� D�Y
ri��
I/ We certify ufWer the penalty oi perju�that Ne ab96e� foregoing infortnatim is We and cortect and that the appluan[ is a resideM of Intliana and
owner I mntrad Wyer of the aforementioned prop�(ty date appliqlion is Sled.
SignaWre (owneh MI reme) Date (monfi, day, yea�
ment atlCre� of appGranl (number antl sGeef, ary, slate, aM Z1PCOde)
� `r i�a��/cv zN, Y��
30`7 S, inQ.n
authoraetl Ey duty esewted Power o( Attomey or by IC Gt.1-12-0.7
s d aWwrrzeO person (num6eraM sbcef, cily, slate, arM LPtode)