HomeMy WebLinkAboutMortgage_Ferguson"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ : FOR DEDUCTION FROM ASSESSED VALUATION
�• Smte Fwm 43709 (R77 / 6-09) �
S f PrrsrnLetl by DepartmeM of Local Govemnient Fuanca
Fil rk
INSTRUCTIONS:
Fartnf�ed '
To 6e filed in person or by maii with the CountyAuditor or Counry Recorder of Ne county where the property is lorated.
Filing Dates: 7J Real Pmperty: Must fJe dunrg tha year fo� which fhe deduction is soughG S P qry q�d��
2) Mo6ile / Manufactmed Homes rrot assessed as Real Pmperty.� Must file dudng the iweNe (12) months
6e(ore March 37 of each year the deduction is sought. ❑� County Recorder
�
See 2verse side for addifional insLUCtbns arM qualificafions. '' �� �'"' �
GIBSON COUNTY AUDITOii
) 10 " � � �
Assessed reAie of real pmpeny as d Mortpa ge / Cantract indebte0nrss unpaid as of Mortgage I Cm?aa mdehtedness unpzid as of Is ihe appfiram the sde
Marth t, artrnt yrar A1art3� Eate o( appGption kgal or equitaNe ameR
I � ❑ Yes ❑ No
If no. what 5 his / her ezxt share of inteJest? If owned wiN someone other than spouse. iMicale with whom
tl rartie m �emftl a CitlrJmt Nan ihat ot aPP�L mdu�le Eeb'+ I5 tt�e property in QuesUm: Mnua%PSUSSed
❑ Real Roaertr � ��N �
. � Abbile Hane (IC G7.7-�
rlame a mwcgas� « mno-act seuu
Pddress oi mort9a9� or contraC seDer (num6� and s0
Name ol assignee w aNe� wmer or halder of mortgage
cRy, vate, aM LP code)
AdCress of assynee (number antl stree; r�y, sfa.e, enO LP mde)
Ooes epplitant own poperty in any oNer
munry in Intlana? _ --
❑ Yes
D���„-�,- �o. aoo.%-..�.�.9�
2�
Sig�nne N Cau�N nuEiter
W
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p- c�� a �o . .....................
County
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Has Nis dedu�]im been reQueste0 on praputy
tar artent yeal? ❑ Yes ❑ i
� � �
I/ We cerlity under the penatty of perjury Nat Ihe above and foregoing intortnation is We.and cortect and Nat the applicant is a resident of Indiana aM
amer! conVact buyer of ihe aforemerrtioned property on date application is filed.
iraWre (a�me(s /utl �ma) n Dale (monM, daY. Yaar)
addres of appfrant (nur�De`r a1ntl sbee4 �Y. ffire, ana [ir od
(5 �. �nic�H p�Trc� Pr��.r��
uaetl Ey dWy esecuted Power W A11uneY a M IC G7.1-12-0.7
PdCr�ss ot autlwr'ved 0� (number eM sbeet �Y. sfate.
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oate (,rionu�. car. rea�