HomeMy WebLinkAboutMortgage_Collins (6)^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ ,: FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R71 / 6-09)
�' ,�,� f P�esaiheG by OePaRmeril of Laal GovernmeM Firexe
VSTRUCTIONS:
�b be lled in person a by mail with the County Auditw or Counry Recorder of the county where the propeRy is bcated.
Fil'mg Dates: i) Real Pmperty: Must file dmirg the year (or which the deduc6on is sought O
2) Mobi/e / Manufactumd Homes not assessed as Real PropeRy Must file dunng the tweNe (72) months
6efore Ma,ch 31 of each year the deduction is sought.
See reve�se side for addi[ional inshuctions and quali�cafions. C
AooGrantl9wneioroonlydC buver - s¢e resfncftims rn 2�erse sdel
�t no. what
an
File
T ��hn�e�mr
�ounry Recorder
GQ� �U GIBSON COUNTY AUDITOR
Key �wmber / legal desaiptirn Record numDer Page number
�-� �� -o�-Yo�-oo3. a��-o�b' �°!I ��a—
cf 2al poperty as of Abrtgage / Contract ude6tedrress unpaitl as of MoRgage / Cantrac[ inEebteErcess unpaid az d Is the a0d��+t the sde
.year Martl�l.wrte�rtY� dateofa7P�� IegalweWitadeowneR
� � /�Q O ❑ Yes ❑ No
o,��a�,����
S /3
a cOnPda Seuer (nunIDP1 ano svee4 �: sldY. ar�a ur CW¢)
name m assgnee or omer owner or muer m mortgage
AECress ot assignee ( mber a� street �y. slate, a IP cotle)
� 1 /J S 7— J. —/ O
any
No
If bwned wiM someo�re oNer �han spouse. W imte with wMm
y o sr �
�� r�� oam
M�ua%ASSessed
�RY ❑
-- - -
Drawcr NO......d�•i.`......
Card \O. ...`�.��.�........
COUNTY AUDROR
Deauctim approved ii the amouN aE
20 20 20 20 _ 20 _ 20 _ 20
Si9�aWrc N Cam� itw Caunry Date (monlh. day, Year)
�-�.
I/ We certify unAer Ne penalry o( ry ihat the a aM foregoing infortnaUon is true and mrtect and that the applipnt is a resident of InEiana aM
owner / contraci buyer of the afore entioned pmpe on date applicatlon is filetl.
• Sig (awne/s fiAI neme) — Date (rtwnfh. daY. Y�A
F �¢sideM adAress d appfrani (numberand st�eel, ' stare, and 2(P cotle)
�! i. . v �`ee i- c e e � ��,,.c� i6 ? 0
Person auUrorved Ey EWy ezearted Power W Ntom Y or by IC 61.1-12-0.7 Dale (monih. EaY• Year)
Pddress of authorrzed persrn (number arM shee{ city, state, anG ZIP oode)