HomeMy WebLinkAboutMortgage_Haake� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
$tatB Fortn 43709 (R11 / 6-09)
�,.r Presvibed by DepaRrt�eN of Loml Gwtmmant Fitwite
INSTRUCTIONS: v�q�
To be filed in person or by maB with the CountyAudhor or Counry Recorder o/ the munry where the property is locatec�U G 1� IU
FiHrg Dates: 1 J Rea perry: Must file durirg the }rearlor which the deduction is soughG County Audhw
2) Abbde / ufactured Fbrtres rrot assessed as Real Property Must file d�ring Me tweNe (12) monMs
6efore Ma�c 37 0( each year the deduction is soughG Counry Recorder
See revers�e for addifional inshuctions erM qualificafions. ��
�MU�"� a�""°_b�,y�'-'ee °"'�{��°) GIBSON COUNTY AUDlit�n I
azd
11 m. what is his I her erarl share ot inieJest?
tl rwna m rem�d's Q�rterent tlun Ihat W appOp�rt.
� contraa ineebtea�resa unpaid as ot
Addreu d mor[gagee a wntraG se�er (rr�rtr�6e end sfrae4 �Y. smm. ard LP coda)
Name o1 assgnee w mlml owner w holder of rtangage
AAGratis of assignee (number entl stree; rdy. sfale, eM ZIP aotla)
Ooea eppfi�-ent own pmperty in any oMer I( yes, whal count7/+
munty in IrWiaria?
❑ Yes ❑ No
�
Sig�aMe d Ca�arty Ntlkor
I / We urWer N�
o( I �s me apW�� me mle
legal w epWtaGe oMT�nYt
❑ Yes ❑ No
wm¢ore other than spp�se. 4dicata with whom
h Ne P�PenY in 0uestion: MmiaPJ Assessed
❑ Real ProPeRY Q A^^�Y �
a�� r� nc �+.
What Tad�g DisMr17 Has Nis deduction Eeen 2que5teE m pmpuly
for wrtenc Y�r � Ye5 ❑ �
2p_ 20_ 20_ 2b_ 20_ 20_
�„ryy oate (irwvn. daY �ea�
nalry t perju at the ve and foregoing infortnaUon is true and cortect and Nat the applican[ is a resident o( Indiana aM
of fhe m oned p rty on date aDPlica ' n is filed.
� i o� cm�m, d�y ,ean
w�O Powrs of At�mbY or by IC
(num0er a�M sbeet Ny, stafe. a
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