HomeMy WebLinkAboutMortgage_Griffin"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
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� FOR DEDUCTION FROM ASSESSED VALUATION
� Sfa[e Fwm 43709 (Rit / 6-09)
� f P�esaibetl by DepaRmen� 01 Lod Governmenl Firence
� File Mark
��NSTRUCTIONS: A'
To 6e filed in person w by mail wifh the Co�ntyAudimr or Counry Recorder of the wunty where the property is bcated. ���
Fifirg Dates: 7) Real PmpeRy: Must file during the year (or which the deducfion is sought. unry Auditnr
2) Mo6ile / Manufactured Homes rrot assessed as Real Pruperty: Must h7e dunng fhe 1weHe (12) months C �
before March 37 0/ each year the deduction is sought Recorder
See reverse side (or additional insWCUOns arrd qualifications. G I BSON COU NTY AU D ITOR
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Asvssed vaNe cf 2al O�G�Y as of Mw�gage / Conb
MarM 1. nrmV yrar Mattl� 1. turte�rt
5
K fq. W�13i 6 i1R I hEf CF2L7 5�12l0 O� NiPlPSi)
11 fwrie m remrd s 6ituent Nan fhat ol app6rant, i�Mifate bebvr.
«contrau s�
R Of COlIb3d
sta12.
Name ot assignee w other owner or holEer of mortgage
AECress oi as4g�ree (number and street cWy. slefe. antl ZIP cotle)
Dces applrcaN wm praperty in any oUer If yes, what munty?
cou^ry in Indena7 r-i .. b9 _.
20 � 20 � 20
20
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T=1�!?�1!!!�±�[7.!S
If awrretl wiN samew�e other than
Page num6er
J �
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rue. uidcare witli vAwm `
tl7�re, popeny m 7urstion: MnuaAy Assessed
J+�� �+�Y ❑ AfmUally Assessed
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AUOI7
No
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�riature of CounHAWitw I Caunry ' I Date (month. tlaY• 1Ta�)
I I We certify under ihe penalry of perjury that the above and (oregoing infortnalion is We and cortect arW that Ne applirant is a resident of Indiara and
owner / contracl 6uyer of the aforementioned properry on date appiicalion is fileE.
Rersm auUnraed Gy tluty ezi
Pddress of au�hora� Verson
ty, sfate. and ZIP �'+�
�x IC 61.142-07
57afe. andLPCnde)
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