HomeMy WebLinkAboutMortgage_Arrick.«�°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (RB! 2O7)
S w� r presoibed by DepaNnenl af Loral Govemment Finance
wsrnucnoNS: MAY p�i�w�@g
To be filed in person w by mad w"rfh fhe CountyAuditor o7 the courrty where the piopeAy is bcated.
Fding Da(as: 1 f Real Pioperly: Dunng the 12 monMs belae June 77 o/ tha yrear the deduction is to be eflective.
2) Mo6ile Homes assessed urMer IC G1.1 •7: Behveen January 15 and Ma�cA 2 of the yea� the deduclion i o
See reverse side fw edditional insWctions ard quelifecations. GIBSON COUNTY AUDITOR
AppicaM (ame` qaeqnLad 6uYer' see re�ic6ms myeverse siae) '�
T DisUicl Key �ber/legalde aiption
.
0.tsesed ralue of real popatY az d March 1� anenl Y� �Ba9a / Contrari inda
wnenl
�
1�1iat is h's / her erati share d imerest?
If reme m recwtl is diReraM Uwi Nffi o( applicant intliote belwr� �
Name of rtqrtgagee ar mNaG sellel �
AdOress of mortgagee d canVaC seller (number an0 streeG rity. ffife. end LP mda)
Narne
a hdder of mortgage
� ���. rn� ��a. �
ooes appi�sm o«n poperty i� ary ana
murrty in Indiana?
❑Yes ❑No
appmved in the amount of:
2p _� I 20 _ I 20
'!'Ud � "'
�ss unpaid as a( MarC� 7, Is the app6<ant Ihe sde legal w equita6ie wmefi
i ❑Yes ❑No
If owred wilh son�eane other Nan spouse. indiwte with wMm.
Is �he proparty in quasUm:
❑ Real Property ❑ MoWle Hatie QC fr1
Dra�►�er 1\'0...��i.C:.:....
..
Card NO. .....�y4�. ''_
� ��& 8ci� � � . . . . . .
. �.
20 � 20
0
�� o� �
❑Yes ❑ No
r.�
I/ We certify under the penaity o( perjury that the above and toregoing infortnation is We and mrred and ihat tlie appliranLS was I were a resitlenl of
I�ana and owner oi the aforementirned properly on March 1, 20
nwhve lmwnels I�A1 namel Dale (monN. daY. Y�/)
6!
a� aWt�or¢ed
(number and s6eet aty, state.
otbylC61.
persm (number and Sheef, c4y. Sfate. aM
Date (month, day, yaa�