HomeMy WebLinkAboutMortgage_Bryce (2)"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T � s i Year
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� FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R71 / fi-09)
S � Presaibed by OePart�rerd aI Loml Gwemment Frence
� I�B
�STRUCTIONS M
To 6e filed in F� �� �:
person or 6y mail wifh Ihe CountyAuditor or County ReCOlder o) the county where Ihe propeAy is located.
Fifirg Dafes: 1) Real Property: Must file during the }rear for which fhe tleduction is sought. C� nty Audimr
2) Mobi7e /Manufaclured Homes not assessed as Real Property: Must file dunng the hvelve (12J months
C Recader
6e(ore March 37 ofeach yearthe deduction is soughc GIBSON OUNTY A
See rev rse side lor addiUonal instnicfions and qualifications.
(owner or contrad buyer'see msfirlans m revr�se siCe) � �
a af
a his / trer exar] share of interest?
-o
� �,�
If rame on remN 5 difluent Nan ihat ot aPP���x �ip4 Cebvr
Nartre ot mortgagee or mntracl
of
m ' / Recoid numbv Page numEu
- 303 -oo - a/9 -oz� a,o � l.o3a-
aa IntlebteOness unpaid as U Mw�qage I ContraC udehtedness unpaid as M Is Ne eppiiranl the sole
yevv dafc of appGcation kgal w epuiHble ame!!
�' �f Q QDO ❑ Yes ❑ No
If awnetl wiM someone other Ihan spouse. i irate with whom
• Is Me GroPertY in question: MnuaDY Assessed
' ❑ Rea� Provenv ❑ NmualNPSSe��
MoMle Fiome fIC 61.1-�
rtnrtgagce w mntrad se0er (nurMri end sbce{ coy, sta�, aM ZIP cade)
w otlw o�mer or twlder ot morigage
aM s�ee( ary, shdte, and ZIP cotle)
po¢s applipnl o.m pmparty in any other
munry in IrMiaru? ❑ YE5
1
�
DaiuUion aooroved 4� �he amoum of.
20 I 20
I/ We certify under ihe penalry ob¢erjury Nat
owner / contracl buyer of the afo2mentioned
Perwn autho�d Ey Guy
�I j���.�
�1
Drawer \TO.. ��.�
Card NO. ...... ���.... ��
COUNTY AUDITOR
20 20 2
Counry
h ve and foregoing infortnalion is true antl i
i erty on date application is filed.
C_.��
ty,�ta. a�dZfPOOtle� _ _ �
person (num6eraMSbee(Wy,state,andLPCOtle)
�
th. daY. Y��
a resident ot Indiana aM
; daY. Yae�
/�/ z_
�f- 76 7 c�
o� c,�„m. ear rea�