HomeMy WebLinkAboutMortgage_Davis (9)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ry = FOR DEDUCTION FROM ASSESSED VALUATION .
• State Form 43709 (R71 / 6O9) 'p'
�' t Presoibed by Departrnent of Loral GoremmerLL Fuunce � Q
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INSTRUCTIONS:
Form Red wNh:
To be filed in person or by maii wiN �he CountyAuditor or Counry RecoNer o/ Ne county where the property is bcated. (j� Q
Filirg Dates: 7) Real Property: Must file dunrg fhe year for which Ne deduction is sought � C � a' �'(;dHnty Auditor
2) Mobde / ManuFactured Homes not assessed as Real Pruperty Must file during the lwelve (12) months
6efo2 March 31 0( each year the deduction is snught ❑ County Remrder
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See 2verse side for addifional inshucfions and qualificafions. °�' "�'
I����.,°M.."efOf�O"��"�ef��r°`""i`�/`ia`.��e� � GIBSON COUN7Y AUDITOR
T ' isviot Key (umber / legal d�aiGtion Reco�d w�� Fage num /�
r� .�=- a�- id - o = 30 - o 0.3. a�s - a� s �rq
As�sed rahie d real pmperty as of MoRgage/ Contract inde6tedn¢s unpaid as of Mongage I Con� rtde6tedness unpai0 az of Is ihe applkant 1he sole
Alemh 7, qmnt yrar March 1 wF` �nt tlate of app�qtun legal or epuitade awnM
(J �C7 O O , ' ❑ Yes ❑ No
�i Ib� W�13� 6 �15 ��12f 0%dfl5�ldl8 Oi Ifl(C1P52�
tt name m iemd's di7emnt Nan Ihat of aPpOCanf, 6Micate Debw.
rtnrt�agee or convact
Name of assiryiee or oNef owner or hoNer M mortgage
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se; ciry, stere, aM LP cade)
AdCress of assignee (numDer end shee4 �Y, ��. � LP cade)
Dces applimnt o+m property in any oNer
munry in Intlana? r-i _ _
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I / We certdy
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�f ONTEd WII�150RICM8 OU18f I�NII SPOILSE.
tl�e D�PertY in Ouestion: MnuaOy Assessetl
2al PfOPertY ❑ ���Y �
MohBe Hort�e (IC 6
Drawcr NO....c,�u,�.l.......
Card NO. .....�q��
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COUNTYAUDROR
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Counry
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Date (rtanN, tlay.
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penatty of derjury Mat Ne above arW foregoing infortnation is We ark correcl and Nat the applirant is a resident of Irdiana aral
of the aforementioned DrocertV on date appiiption is filed. ,
� Sigtature (ox+te hN �
� Full resitlent adtlress of appf�nl (numEer and f, rJ te, and Z/P cn
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� Person aurtro�aed Dy Euty exMVteA Power o( Atlomey m Dy IC 67.1-12-0.7
Pdtlress of aNhavcd person (number aM sbee; cRy, sfale, an0 LP mde)
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Dale/(p/�q/��' ysa
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Date (monlh. EaY Yea�