HomeMy WebLinkAboutMortgage_Case"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ . ; FOR DEDUCTION FROM ASSESSED �� � �
Slate Fortn 43709 (R71 / 6-09)
� w. t PresviEeC M DePartmeN of Laral GovemmeM Firerce
File Mark
�NSrRUCnoNS: AAAV 1� ZO11 FonnAed,V;,h:
To be filed in person a by mail wifh the Co�ntyAUditor or County RecoNer oPtf('�oun where the property is focated.
Fi/ing Dates: 1 J Real Properiy: Must file durirg the year for which the deduction /'� s�p �unry Audimr
2) Mobde / Manufactuied Homes rat assessed as Real Properl� M}+s't A15E�hvelve (72) months
before March 37 ot each year the deduction is sought ❑ County Recarder
Seereversesideturadditiona/instruuionsandqualifications. GIBSONCOUNTYAUDITOR
Appficant( � con b�re�-see re vdel
��e��eny�w
anera year
It no, what is his / her e�c1 sham ot interest?
If name m remtl a ddteran tlun tha� at appGwi4 mdinte bebw.
g� ar mntract se0er
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Counry
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"vitlnb[etlne53 unp3id a5 0l Is U�e applitlnt the sole
Yes LI No
sW�se.
is Ihe property in puestion: MnuaDy Assessed
❑ Real Roaem� ❑ ��N �
Mohle 1-lorrie OC 6
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Date (mortlh, tlaY YpaA
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I/ We certify under Ne penalty of peijury that [�i above anA foreg i g intwmation is We and cortect and that Me applitant is a resident of IMiana and
owner / mntrayl buyer of ihe afommentioned properry on date ap � tlon is filed.
7{qwr9lo s fi+0 �me) _ —� Date (rtnnN. daY. Y��
Permn
ol applf�nt (number and sbcet, ciry,
61.
pe�swi (numberanAStree; city, state. aM ZIP wde)