HomeMy WebLinkAboutMortgage_Bolin^�n STATEMENT OF MORTGAGE OR
_ . • FOR DEDUCTION FROM ASSES:
Sfate fwm 43709 (R71 / 6-09)
�` y„ � J presaibeE by Departrtrent at Local Govemment Financ_
�srRUCnoNS: AUG 1 5 2012
To be fded in person w by mail wrth the CountyAUdifor or Counry RewNer of the cou� where fhe poperty is focated.
Fifirg Dates: 7) Real PropeRy: Must file dumig tha year for which the deducLOn is sought�
2) Mo6ae /Manulactured Homes irot assessed as Real Property Must fife dunng th (72) months
6efore Ma�ch 31 of each year the deduction is sought.
GIBSON COUNTY AUDITOR
See reverse side (w�diGOnal instructions and qualifiratio�,r t.
�nppfrant(ownerw, uyer'see re �
File Mark
Fortn fil wM:
County Audrtor
Counry Recordu
is'�jf�/W1VTi neY�mnuefy�e9a�/d'/��'/V� 0b . 77�-Od� n�w��CV/Q r��i)`--'�
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1 vahre d real property as W Mortgage/ baU intle6te�ness unpaiA as W Mortga9e / Con� inOeMetlness unpaid as d Is ihe apPli1ant Ne sole
arrmtyear Mard�l.ia�nWrar� ^O^ dalaofaGPlkation ����"'I YfSe❑ oN
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I hes era�Y shara of interesl?
It name on recwd's tlittuent Nan t�at of aPpOCan4 uWiqte 6ebw:
Nanre M rtnrtgagee or contraG
AddreR ot rrort9a9ee ar
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sbaeL �y. s+ata, aM LP code)
nqrtgage
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5'gretlne U Cowb AiMitor
If owne0 wiN someone other Ihan spouse, iMicate wtth whom
Ls ttie ProPenY in Vuestion: MnuaOy Assessed
❑ Real RoPe�b ❑ ��Y �
Madle Home (IC 67.
� - I fw w�ren� yeaR
�ur+n auoRaR
2� 2� 20
requestetl m P�Y
❑ Yes ❑ No
Date (manM, daY• Y��)
zo
I I We certify uMer the penalry of perjury that the above and foregoing infortnation is We and corteU arM Nat the applinnt is a resident of Indiana aM
ovmer I contracl buyer ot the aforementioned {yqperty on date applintion is filed.
Pason 3�thon�tl Cy
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w by
per'.,on (number aM sbee; dry, stale. antl LP code)
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