HomeMy WebLinkAboutMortgage_Fisher (5).a "'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
� FOR DEDUCTION FROM ASSESSED VALUATION
S1ate Fwm 43709 (R8l 2-07)
S y�• r Presmbed by DepaM1menl of Lacal Govemmenl Firence
�NSrnucnoNS: JUtf���M��008
To be filed in person o� by mad with fhe County Auditor of fhe county where the propeAy is located.
Fdv�g Dates: 7J Real Property.� Dunng fhe 72 months befae June 11 d the year the deduc6on is to be elfeclive. �
2) Mobrle Homes assessed under IC 6-7.1-7: Behveen January 15 and March 2 0/ the year the deducfion is fo b8 e�v�
See reverse side /or additional instrucGons arM qualifirations. GIBSON COUNTY AUDITOR
' - see restpcjrons m ieverse
.. / 1 1
_.r �cii Mo
Disirip Keyr{Sm6erllegal
�ii'iC���^-� v� '/ / -
ed rdlue ot rral popPtly a5 of Mard� 1, ament yrar
ezact
that ot applirant. intlicate below:
of rtangagee or mntrxt selter /7 �
-�04�-000. �,3D - O �-5'
7e / ConUac7 indebtedness unpaid as ot March 1.
� � �.�QQ
Address of moAgagee or mnirad seller (numbrs aIM({free(. dty. 9ate, arM LP code)
Name af assignee w olha awner or hdder of matgage
Address of assgnee (numbei and streeG dty. siate. aM Z!P code)
Dces applicanl own property in arry olher It y
counry in Inda�?
❑Yes ❑No
Deduciion approved in Ihe amwnt of:
20� 20 _ 20
> ey�uae wmen
❑ Yes ❑ No
spouse. ��'ate with whom.
Is iha propeM in question:
❑ Real Procerlv ❑ Mobile Home OC 67.1
�ZS !� � I�-G� � `�����:
J Aa � A
counlY? Whal Tazin� n r��s � f �IJ C �/'7N�
l..Y
�'(a�C; dOD"� �Go� 3S-?.S' �
couHrvnuorroR
20 _ � 20
�
Dale (monfh, day, yea�
20
1/ We certify under the penaity of perjury that fhe above and foregoing infortnatio� is true and mrrect and thal Ihe appiirants was I were a resident o(
Indiana and owner of the aforementioned property on March 1, 20
p�Wre (owne(s fidl partre)`� O. _ Date (monfh. daY.Y��
execvted
aQd 3tre�t. afy. state. and Z!P code)
or by
Pddrrss of aultur¢ed pe+san (num6er arM sUeef, aty. slafe, aiM LP mde)