HomeMy WebLinkAboutMortgage_Keehn.+°"� STAIEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
` FOR DEDUCTION FROM ASSESSED VALUATION ��
State Form 43709 (R8/ 2-07)
�' � j Prrsrnbed by Department of Local Govemment Finance
File Mark
�NSraucnoNS: MAY 0 8 Lt�08
To 6e filed in person or by mail with the CountyAuditor of fhe county where fhe properfy is located.
Fding Dates: fJ Real PropeAy: Dunng the 12 months be/ae June if of the year the deduc6on is to be elfecGve_ �
2) Mobile Homes assessed under IC 6-7.1-7: Behveen January 15 and March 2 of fhe year the deduction is to be e� ��
See reverse side Ja additional insWctions arrd qualificafions.
GIBSON CO
Appliranl (owner m m r- see re ons on reve sde)
_ � • fy"�A'"e• ,�''�" .�� o � ., _ / _ _ � .,., i
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d��! - la - 4��3 - p 3.OSY-Ua- 8
rdue ot re� papaly as d Mardi 1. anenl ymr Mortga9e / ContraC iMebtedness unpaid as of Mamh 1. Is Ihe
wrrenl year
83 0�7
his I her ezacl share of interest?
Ii �me on record is diflerent Ihan Uial
Name of mortgagee or conlraU
w mnlrac7 seller (n�mberaM sbeet. dty, state, aW ZlPcrotle)
af assignee w Wher owner or hddet of mortgage
Address of asagnee (nurMel and sfieei.
appGmntU�e sde legal or eqtritaWa wmefl
❑Yes � No
If owried wilh someone dher Ihan spouse. �cate wifh whom.
. Is Ihe properly in question:
n.._._��---� -
❑ Real P�ert�— ° 1
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Q ��_ �5.�3
v�-:,,•; �,� ;�o.aU. . .
i,�iT(i \0 . : .......... ....... D
�e, /� � �,r�n c.ti+cca�' � �''G 2� . G ,
Does applicaM own poperty in arry ottier I If yes, whal counry?
counry in Indiana?
❑Yes ❑ No
DeduCion app�oved in Ihe amaunl
20
SignaWre of CounryAudilnr
20
COUNTY AUDITOR
20 20 _ 20
Counry
Has Uus dedudion bcen requested on property
fa wnenl yeaR
❑ Yes ❑ No
20
Date (mon(h, day, yea�
Y3��
I I We certify under the penalry of perjury fhat the above and foregoing infomiation is W e and correct and tlial ihe applinnts xas / were a resident of
Indiana and owner of the afwementioned property on March 1, 20
`�ature (ownefs Mname) Date (monN. daY.Y��)
ai applicaM (number and sUeet cRy ate. arM LP wde)
�� i a,�v� �P . r r it Cef4t-.
dury exeW ted oxef of AllOmey a by IC 61.1-12-.07
Adtlress of aulhar¢ed persw� (number aM streel. cdy. sfate, arW ZIP oode)
oa�e (maim. car. r��)