HomeMy WebLinkAboutMortgage_Gray (8)"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Caun
,. = FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fortn 43709 (R71 / 6-09)
, H,. f PresoibeC by OePe�rt�M of Laal Govemrtrent Fnance
��srRUCnoNS:
o be filed in person w by mail with the CountyAWitor or Counry Recorder o/ the county where the property is located.
Fitirg Dates: 1J Real Properry: Must file dwi�g Ne year for which the deduction is sought.
2) Mob�7e / Manufactured Homes rro1 assessed as Real Properfy Must file during the tweHe (f2) months S
before March 37 of each year the deduction is sought.
See reverse side foradditional insfructions and qualifrcafions. C.
npq�icant (oy+ier w conhaa byre�- see resMrtiqqs m reversa side) A _ A
i Oik Key mimber / le9al EeSCriPtbn
��,, �, -,�a -
1 ralue a real poperty as of o�(g age / Cantract irde6
�+�artyear Marcyyarren(year
tl nart�e on
P [�. untyAUditor
[�j2 ry Remrder
,� Zf�(�,yy�� GIBSON COUNTY AUD
�� s(/ Record number Pa/g�e/ nu
iid as of Mongage I ConSaa iMebtNness unpaid a o Is Ne eppGmn�
date of appGration legal n equitabl
❑ Yes
exad share o! interest? I( owned wiih someone oNer ihan spouse, iMicate vrith wtrom
iRerent Uan Nat ol aPP�^l "c�A'uate Deb�r. Is Ihe ProPertY in VuesUrn: MmiaAy Ass¢sed
❑ Real PrOperty � Nmualh� Assessed
Name at rrortgagee «cono-aU seller �
'
Mdress o( matgagce w convad seller (number arid sbee; tdy, sfafe,
rume o� assgnee w omn mmer w naaer m mortgaga
antl stree4 �y. slate,
Oces apd��nl wm prapercy in any oNer
counry in InEana?
❑ Yes ❑ No
COUNT
approved "v� tlre amOUN oF.
—'— � 4 cr V •"'
��c���
5(3-r�� s����
�9 �, aoa�
1 on property
No
20 20 20 20 20 _ 20 20
Si9na4ire of Camb Audiiw ' County Date (rtanN. daY. YEa�
1/ We certify under the penaly of perjury Ihat Ihe above aM foregoing informalion is true and correct arW that Ne appliqnt is a resident of Iridiana arM
owner I contracl buyer of Ne aforementioned property on da[e applicatlon is filed.
Q appGnnt (numbe�nd sheet, riry, slete, arW L
A.1�90 S"�" �
1Wy ezewtetl Powu o(Attm�ey w by IC 61.1-12-0.7
pert.on (number arM Snee4 �: sfale. aM ZIP cade)
(rtmfi.
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