HomeMy WebLinkAboutMortgage_Barrett (5)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
: FOR DEDUCTION FROM ASSESSED VALUATION
• Sfata Fortn 43709 (R71 / 6�09)
� S PresaibeE by DepartmeM ol Local Govemmenl Fl`axe
F'I
INSTRUCTIONS:
To 6e Aed in person or by mail wifh Ne CounlyAUdito( or Counry Recorder of the county where [he poperty is located. F� �� ��
Filirg Dates: 1) Real Property: M�st file during fhe }rear for which Ihe deducfion is soughL MA 1� 24�Junty Autlitor
2J Mobr7e / ManWactured Homes not assessed as Real Prnperty: Must file durirg the hvelve (72) months
betae March 31 of each year the deduction is sought. !, � M.�. Counry Recorder
See ieversa
�
GIBSON COUNTY
�� � ��-- a-i��-000-�y�-oa a
ed vapie cf real p(aperty as W Abrtpa ge / Contrati'udnbtetlness unpaitl a o( Mortgage / Con'vaH citlebte0�mss �mpaid as d Is 4re eppGmnl Me sde
1. ormm y'ar Mem)� 7. n�rtent date W aOP�� legal or eWitade o�nM
� ❑ Yes ❑ No
ihat ks his / her euU shara oi interest? It wmed wah somearre other ihan spo�se, iMirate wiM hMm
^ m remN is 6RSent Nan that of aPW�. u�Eiote Eelov` Is tt�e DroP�Y in Ouesoon: Mnua9Y Assessed
❑ Real P'oPeNY ❑ A^^�a��Y Pss�s�
Moble Hpne IC 61.1-1
ot rtartgapee or mntract sellu
SI �
s ot rtart�jagee v contrect seller (numDri end sbce{ �y, �(¢, aM e)
Name ot assignee w oNer owner or hdder of mMgage
Address of assignee (number e� slree4 tlry. s+efe, an
Does eDWipnt own property in any oNer
munry in Ind'ana? ❑ Y�
❑ No
De�uction approved N Ne amount al:
20 _ 20 _
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Dra�rer i\'0....�( "
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Caunry
Ye�
2q _
Da�e (rtronth, daY Y��)
� G�W�+�Y
2(1 _
I/ We cert'rfy under the penally ot perjury that the ahove and foregoing infortnalion is true and cortect arid Nat the applicant is a resident of IrWiana arW
awner I mntracl buyer,qf the atoremen}ioned property on date applipCon is filed.
esecuted Power
of authafaed person
by IC E7.t42-0.7
��.
Date (rnmfA. OaY. Y��)