HomeMy WebLinkAboutMortgage_Lambert"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (R77 /6-09J
,' d Presaibed by OepartmeM of L.o�al Govemment Fi�nce '
il a
wsrRUCnoNS:
F� mea wm,:
To be filed in person or by mail vri�h the CounryAuditor or Counry Recorder o/ the county where the property is located. � c 9j�
F7'vg Dates: i) Real PmpeRy: Must file during the year for which the deduc6on is soughG S uCOUr�Ty��dimr
2) Mo6ife / Manufactured Homes not assessed as Real Pioperty: Must file dunng fhe twefve (72) months
before March 31 of each year Ne deduction is sought. �
C. .
See reverse side (or addifional instnicG'vns arrd qualifications.
App5ran ' �nero oontraCO sr-seere
i
Ta DismG Keyru
�����ffi�
Mart3i 1. tlnenl year
1
.t ro, what fs his 1 her exaa shara of inir.rest?
If nane on 2mftl a Wflgent Uun ihat o/ appl
Name of nprtgagee or mntrap seDer
;-�.I�.=o?-ao4-
Mor(qage / ContraU "ude6te0�ress unpaid a �
Marrh 7. arr�p yp�r __
Gelow
K ovmetl vriN
GIBSON
Remtd
Yes L� No
Is the propeny in Question: Mm�aDy A55e55tW
❑ Real PioPerty ❑ Mnually Assessed
Mobile Home (IC 61.
�
Pddress of mortgagee w mntract se�er (nurtiber and stree4 tay, sbte, aM LP
Name of assignee or oNU ownet w holder W rtqrtgage
AGdress ol assignce (number aM seee4 �: s
Ooes applicant ovm pmperty in any oNer
county in InEiana? ❑
❑ Yes
Drduction approved in tha artwuni oF.
�
Sig�Me ol Camry Auditw
__
D►•a�ver NO..G�O.� �......... ,
Card \ro. ..... 39 a�
4��p, goo'°a
ZO _ � zU � _
Counry
� P�WertY
� 20 20
Date (monlh, tlaY. Y��
1/ We certify under Ne penalty o( perjury that the above and foregoing informalion is We and corzect arM Nat the applirant is a resideni of IMiana arW
owner I wntracl buyer of the aforementioned property on date application is filed.
�naLire /s hAI name) c� . Date (rtionM. daY• Yaa�i
(number anE sLee4 mY. �te, aid LP code)
I �
oy a�
ot autharsed person (number aiM streef, dry, state. arM LP mde)