HomeMy WebLinkAboutMortgage_Bailey'° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / fa09)
�' Rrsaibed OY �b of Local Govemme�n Fu�arce
�"' File Mark
INSTRUCTIONS:
F
To be fded in person w by mad with the Counry Auditor or Counry Recorder o! the counly where the poperry is located.
Frfig Dates: 7) Real Property: Must file tlurirg the yrear for which the deduction is sough[ n Counry Auditor
2J Mobde / Manufacfured Homes not assessed es Real Prt�peAy: Must fJe dunng Me twelve (72) months `y'�n � .. �
belore March 31 0! each year tAe deduclion is mught.
See reverse side lor addiriona/ insWCtbns and quelifiwtions. GIBSON COU NTY AUDITOR
�'L�,
If rm. whal is his I hef euG shara 0( inf�t?
N narne m remtl b 6fte�ent Nan ihat of a7P�^�. uWMam
�����a�,�� ��
Address of nvtgagee or mntraG se�er (nuMar end sm
Narne svgn� o �a�d�
Adtlress of atsi,p�ee (mnnbereM stree; tltY• sfefe. aM
Does e�nt awn D�DMY in anr oMer
muniyu�ItWana? f'"1 .,__ I-1 .�_
� `l- �� 3-�/
; / Cantraa'udebted�ss unpaitl as of
anentyear
crty, state. ard LP cade)
,n�myr � wrm r�
mrneona
0o io � �.S
5s unC� as ot Is tlre ePP tlnt the sde
k�l a ea�ta6�e ownelt
❑ Yes ❑ No
e. iMiote with whom
ppperty in Ouesbon: MmiaM PsseSSeE
'.al RoPeKY ❑ Mmually Psse�
a� r�„a nc ��.i-;
D�-�,,.��- .to....a....o. �.o.....
C�I'[] �'�. ... � � �........
�q �'1 3�D.0�
2p _ 20 _ 20 _ 20 _ 20 _ 20 _ n1 _
�renrte d Camb Autlimr CaumY Data (rtantl1. daY• Y��
I/ We certify u�er the penatty of perjury that Me above and foregoing information is true and cwrect aM that Ne applicanl is a residertt of Ind'pna arcl
ovm I contract buyer of e aforementioned property on date appliration is filed.
� yg vw (ewmn h� remel Oate (momfi, daY. Y��
� FtiP
Person
r^
tily, st�. and
dWr exewted aowerr�JrAtlnmay «Cr �c frt.i 1z-0.�
permn (number aM stree4 �'. sbte. and LP code)
�
� �?O
Date (rnoruh, da}: ysar)
�.r`_- - -
1