HomeMy WebLinkAboutMortgage_Gilbert (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip ea
_ s FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R11 / 6-09)
,' ,�,� � P2saibetl by DeP�M of Local GovemnrtM Finance
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wsrRUCnoNS:
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To 6e lled in person or by mail wiN the CountyAuditw or Counry Recnider o! the cuunry where lhe property is located.
Fil'mg Dates: 1) Real Property: Must file d�nrg the year (or whicA Ne tletluction is soughf. � �pun i r
2) Mo6de /Manulactured Homes rat assessed as Real Property Must file dunng Me M1reNe (12) monMS GI S0�0����{Q�a�R
before March 37 of each year the deduUion is saght.
See reverse side 7or additionel instrucdons and qu2lificafions.
Ap ownarorconhaU6uyer-see onreyersesitlel_ //% . �/ /1
i � papeny at
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i6er/legaldesaiption �{ R�eg(y/d� nump¢r P numDSrl/
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Mortgage /�� ba� htedness unpaid as ot aM �9 f9 PP"�� uMeMedneca �mpaiE as of Is�Ue � tal de eownM
1
O �� ❑ Yes ❑ No
tt ovmed wiN someone ather Man spouse. fimduate with whom
name on'eco�d is dtlferen[ Nan that o1 app�n� uM'vate bebw:
Name of rtiat9agee or conveu se�er
Atld2ss o1 rtnrtgagee b contraq seller (nuniGer eM sb
Name of assi�ee w othei wmer w MNer M morigage
saee4 uN, s�ete,
Dces eppluant am pfoputy in any oNer
munryinlneana? ❑ Yes ❑ No
Dr�uctlon evw�d in
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Sgrenne N Camblu
I / We ceNfy un[
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tl yes. whal muntyi
WlalTaring Distrid?
Is Ihe property in question: MnuaOy AssesseE
❑ Real Rnperty ❑ Armually Pssessed
0.bdle Hmie fIC 61.
s Nis deductian been reQuested m propelty
arrenf YraR ❑ Yes ❑
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umy oa�e (rownn, ear. r��l
ard 1Yp,
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���''' oon is we and correu arM ihat Me applirant is a resident of Indiana arW
,� i zj �/�\ �.
/ . v v Date (monfi. daY• l'�a�
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ni (nurnber anQsbeeG �: S�te, antl LP qotle) i
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esewted Power of Ntomey or by IC
of auttpmEd person (numberaM Sbeet, Cify, 5tdte, end ZIP CaUe)
o� �,�r�. ear. r�n