HomeMy WebLinkAboutMortgage_Devine (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Year
_. � FOR DEDUCTION FROM ASSESSED VALUATION
. . . �• Sfate form 43709 (R71 / 609)
�' f Presrnbed by Department of Ln�al Covemment Frenca
�� File Mark
lNSTRUCTIONS: AU G
To be lled in person w by maii wifh the CountyAuditor or County Recorder of the counry where the property is located. ����
Fi6rg Dates: 1) Real Pmperty: Must 61e during the year for which fha deduction is soughG C-�. f (;ounry Auditor
2) Mo6de /Manufacfuled Homes rrot assessed as Real Prt�perty Must file dunng the fweNe (12) months
before MarcA 31 o)each year the deduction is sayht �nty Recorder
SeereversesideforadditbnalinstructionsarMqualificafions. GIBSONC '
Key rwmber / legal tlesaiption v Reco�d num6er
�•�-U�-^f �-� �•Z�%Q �aD (J/
��i9a9e / Contre� 4We6tedrress unpaitl as W Mortgage / Con�aU ifMe6teeness unpaiO as of
Match 7, wrtent yeer date of appGtatian
r .wn i c� rti
wssessed raAre d real popeny as d
Mazfh 1. aa�enl year
If Iq. wha� is his / hu e�f2 share OI interesl?�
It r�artn df �emd is drtfemnt tlun fhat o/ appOcai
Nama of rtartgagee or contraa selkr
6�dinte 6ebw.
Address af mortgagce or mntraa seAer ( nwnber and saeeL �y. s+ate. aM ZIP code)
Name at assignee w oihu owner ar Imltler of mortg
ACdress of as9gnee (n�mber aM slree4 �y. smte,
Does epplirant own property in any oNer
munry in Indiana?
❑ Yes No
� �
' in ihe amount of:
20 _ 20
Synature of Caunry Audita
If yes. what
ri�
-
� .
wNn au
20 _
Counry
ottw! ttun sPouse.
Page number
ves u r+o
Is tlre P�PenY in GueSGOn: MnuaOy Assei:ed
�RealProperty Q'MnuaOYA`^sessed
Modle F�bme fIC G
9
• •a.01�• ' O
�a��'er\�".•. ' , � —
D � �31�5 -
Card�O. ..�•3�i-�9'1,13i p=
Date (month, tlay,
I I We certify uMer the penalty of perjury that the above and foregoing intortnalion is We antl correct and that the appliqnt is a resident of Indiana aixl
owner I wntract buVer of the atoremerttloned property on date application is filed.
• `._ y/�� �
! /� � ..i%n,��
ss of appfi�n� (numDerand street,
�v ., ,,, r S-1 /7 r .
Gy EidY ezeWleE Power of Atlome�
� persan (number arM street, cif!
dry, sfate, and LP ootle)
Ey IC Gt.142�]
Date (rtmfi. daY.Y��
Yea�
_""""_"'_____'___'_""'__'___"'"""