HomeMy WebLinkAboutMortgage_Miller (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
' State Fwm 43709 (R71 / 6-09)
` � Presaibed by Oepartrne(ri af Laml Govemment Finance
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INSTRUCTIONS:
To 6e filed in person w by mail witlr the CountyAUditw or Counry Recorder o/ the wunty where the property is located.
Fitirg Dates: 1), Real Property: Must file during Ihe year /or which the deduction is sought.
2J MobRe / Manulactured Homes nnt assesced as Real Prtiperty Must h7e durirg the fwefve (72J months
� be(ora March 37 0/ each year the deduclion rs sought.
See reverse side for additional inshuctions arnl qualfications.
MP��t( roraon7raCbuyer-see mreversasidg) — - -
AvessedvaWedmalPW�Yasol Mortpage/Canc
Ma�tli 1. anr�V year Mard� 1,�
I �[
Il ro. Whd� LS hISI hM CF3CI Sh81B 0( VISC!¢5(? �
If nane m �ecpA is SAfermt than ihat of aPP��t ���e belrnr.
�h�P Y�� y
ark
cCooahAudRUr
a c�iii
Counry Recorder
GIBSON COUNTY
i Reco�d num6er Pape wm0a
-t - , ao-Dao
� indnbtetlness unpaid as d Mongage / Contrarl uWebletl�ress �mpaitl as d Is ihe eppBrant the sde
�ear Eate ot aOP� kgal or eWib6k or+iM
❑ Yes ❑ No
ff 01MCd W11�I SOf118O(IB OI�IBI i11dll 5p0115C. {f1�IC8[B WII�I NTIOffI
Is the property in Question: MnuaOy PssrsseA
❑ Real RoPenY ❑ !�����Y � . . _
gee ar mntrad sWer (n�mOe� and sLeeL uh: sbte.
w Wrer wmer m MIAe
MOm55 oi assyfle@ (n11mnC� alw suee4 �
Dors aPplimnt wm WoO�Y in any ather
cou�uy m Intliana? ❑ Yes
amount of.
20 I 20
I/ We certify under the penalty oi
owner / contrad buyer of ihe afor•
�
�� \-- ' I_U��3
P�n au0n�d Oy OWy ezewced Pwer of Attwnay w Cy
Pd�ress of authw'vEd persa� (numberaiM sbeet �}: sfzfe
D�P�Y
❑ No
�_
�.�Y��
a residem of IMiana and