HomeMy WebLinkAboutMortgage_Bailey (8)1 '
° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
.. FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Form 43709 (R10111-08)
�,.,. � PrewibeE bY �Ga��l d Local CwemmeM Finar�
�NSrnucnorvs:
To be filed in person or by mad witl� the CouipyAWitar d the county whera the property is bcated_ � 0 09
r;w;�y ���: �� a�� r,��y: M�r raa a� wa yee� �. wnra, rna eBa� ��,ync J U N 2
z) Moaae i Marn,�awned rfomas r�d essessea as aBa� ProF,erry ntusr rde dunrg a,e nrenre (�2) monms ae�o+e Maru, s� o� eed, year
the esCuUion is saight `-y�,
See reverse side for addXional ins6vdiorts and qualficafions p'(R .�!�
o{mero�cweiaciM�yw�me�� miovwasside) GIBSON COUNTY ALI�ITOR
.,/J 1
Assesse0 vahe of fa
Alam7i 1. airtaM �ear
ro, whal is hs / hn azad share d i��esl?
axiem year
on ramra 6 Qaarem u�an u�at ot ap�n�. u�d'ram habr.
d rtnr�agea or caniraG se0m
Narre d assignee w oC�er owrrer n MNm d morlpage
Yes
DeEuclbn a07�'ed in die amouM d
� �/vv
�ss unpaid as
�
un{eid as d Is lhe applicaM Itre stila
legal w epuRable ax�neR
) ❑ Yes ❑ No
spouse,
� �e v�M � a�,eaian: nnnuaM ncsassed
� Rral Pmperry ❑ Mnualy Assessea
- Motile Nortie (IC 6
rLy, sGb. aM Z/P mdc) _
rc �� �7 �JJ+✓�R Ii�i _-a, ws aeeuaion eea, �eo�ested on v�veM
❑� r�• �, �r rurtam yean � Yes ❑ I
V
Dra�ver Np, aQ�
20 u T � 20 _
Signature d Coui4y Audilm
Card NQ, 5b�
�35,7p3.� ..........
�h
20
oate (muilh. day, yoar)
20 _
I/ We certify uMer Ihe penalry af perjury that the above and fwegdng mfortnatan is true antl corted and thal Ihe appliwn� is a fesident af Intliana and
owner / wntrad huyer af the aforementio�eC property on dafe application s filed.
F,��
w
REArass d author¢eE person (numGr andsLCW, cily, s�afo, and LP wCO)