HomeMy WebLinkAboutMortgage_Dillon°'n STATEMENT OF flAORTGAGE OR CONTRACT INDEBTEDNESS Count 7ownshi Year
. FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (R8l 2-07)
�O f Presmbed by Department oi Local Go�.eemment Finance
INSTRUCTIONS: ' .JUL ? IeLVJu
To be filed in person or by mad wdh the CountyAuditor of fhe county where the property is bcated.
Fding Dates: 1 J Real Prope/fy: Dunng the 12 months be/ore June 11 0/ the year the deduction is to be efFecdve. `-yy� /{
2J Mobile Homes assessed under IC 6-7.7-7: Behveen January 15 and March 2 of ffre year the deduc6on is�to�fiB�Ne"cfi �
Seereversesidelwadd(ionalinsWctionsandqualifications. GIBSON COUNTY AUDITOR
Appl' (avner m mnlrad buye� - see re" m reverse side)
i- DisftiQ Key num6er / legal tlescnpibn RecorO number Page number
�y� -�� - ioa -ooa. rr�-9 -va� 08 3�79
Assessed rahie af real popaty as d March 1. arreM year Mor�qage / ConVacl indeh�edress unpaid as oF Alarch 1. Is �he appGpn� Ihe sde legal u equitade owne(?
artenlyear � �
his I ha ecact share
applicanl intlicale belaw:
caniract seller
Address of rtartgagee u conlrad seller (number and sfreeG
Name ot assigriee n dher owner w hold
Address of assignee (n1mibei and sVeel.
Does applicant own property in any oU�er
county in Indiaria7
❑ Yes ❑ No
Deduction approved in Ihe amoun� ot
�
SignaWre of Counry Audrtor
�
sla(e, antl ZIP code)
I� yes, what
_�
8�� ❑Yes ❑No
I( owned wiU� someone aher lhan spouse, irWicale witli whom.
in question:
;rty ❑ Mabile Hare QC E7.1
�_- ��' }LE,�l1�'�
COUNTYAUDfTOR : /1M�,�,�
��/� . .
� —r a�'3/��
Caunry
day y�A
h
o�
I I We cerGfy under the penalry of perjury tliat Uie above and foregoing information is We and cortec[ and tha[ tlie appGCanfs was ! were a resident of
Indiana and owner oi the afwementioned property on March 7, 20
�rature (owne/s fWl name) �� n^ Dale (rmrth. daY. Y��1
(� 11\ I
adtlress of applifanl (num6e� and streel. ci(y, sfate. arM ZI co0e)
� 'S f�Gri-f �'� �r.�.✓CL°fOn/ '�!'�%�
w¢ed bY 4uN executed Power of Ntamey a by IC 61.7-12-.07
of aullqr¢ed pasan (numbet arM sGeeG aty. sWte, aM LY wtle) �
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