HomeMy WebLinkAboutMortgage_Koonce.!�"��A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
,;s;_:.,; ', FOR DEDUCTION FROM ASSESSED VALUATION
' S1ate Fam 43709 (R8 / 2-07)
�O � Presmbed by Oepartmenl of Local Govemment Finarice
Fi M rfc
INSTRUCTIONS:
To be filed in person or by mail wdh the CountyAuditor o(the county whe2 the propeRy is located.
Fding Dates: i) Real Property: Dunng fhe 72 months be7ore June 17 of the year the deduc6on is fo be effecfive. ��� 1 Q 2��8
2) Mobile Homes assessed under IC 6-1.7-7: Behveen January 75 and March 2 0( the year fhe deduc6on is to be e e.
See reverse side 7a additional instrt�cfions and quali�catrons.
o�s�,;a
seamsGicfions on
Key number / legal deunplion
_�7_�e,�1.�n�_
Assessed value of real popaty as of Mamh 1, oment y�r
exacl
If name rn recmd is diYeren� �han Nat of applirant, indinte below:
/ /1
Name of mortgagee or cantracl seller
Addrws of rtqAgagee m mniraci seller
Name of assignee w dher owner or
city, state, aM Zll
Dces applicant own pmperty in any oiher If ;
counry in Indana?
❑Yes ❑ No
Gion approvea in the amount of:
20�,p 20 20
/
iW re af Caunh Auditor
sfafe.
7sy-f,b��
unpaid as of March 1,
GIBSON
Rewrd numb
Is �he applipnt Ue sde legal
IF owned with someone dher than spouse,
�)1':1\VG' �'0.�.�4^�.J•� ..:..�..
�;
• �-_�;19;y:�..
C:11�(� �� . .....................
. ���5,500�'�
..
�
20
❑Yes ❑No
Is Ihe property in quastian:
❑ Real Pmperty ❑ Mobile Home QC G7.7-7)
Has Utis AeduAion been requesietl on property
fw arrenl yea(?
❑ Yes ❑ No
��
Dale (rtronlh, day, yea�
20
1 I We certify under the penaly of perjury ihat the above and foregoing infortnation is We and corteG and that the applicanLS was / were a resident of
Indiana and owner of Ihe a%rementioned property on March 1, 20
Dale (monih, Oay. yea�
sfreet. cily. state. aneZlPmde)
tl 6y duly ezeculetl Power of�tomey m
�. L
persa� (numberaMSbeeLaty,stafe,arMZlPcode)