HomeMy WebLinkAboutMortgage_Lee1"'� STATEMENT OF MORTGAGE OR CONTRACT INDF�i t� o 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION@-1 � Y
• State Fortn 43709 (R17 / 609) � A g.J
� � Presai6etl Ey DePa�M o( Lad Govemmenl Financa
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wsrRUCnoNS:
MAR 3 0 2011 Fiie Mark
To be filed in person or by mail with the CountyAudifw or Counry Recorder o/ the county whe t � �� Fwm hle 'w:
Filing Dates: 1) Real Pmperty Must file dunng the year (o� whirh the deduclion is sought. ��� Coun Audilnr
2J MobBe / Manufaduied Homes rwt assessed as Real Property: Must �ile during the lvreNe 2 ths ry
befaeMaich37o1eachyearNededuclionissoughG GIBSONCOUNTYAUDITOR ❑ �ntyRecorder
See reverse side far additional instruU,fons and qualifiwfions.
MP�nt (owner6r " tr�e �iyer see °7� s'?51. _ n"
amnt year
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If rwne m remrE s d�Reren[ Nan that ot app0�nt, uidirate Cebw.
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AilGress ol assig�e (number aM stree; tlry. slate. and ZIP code)
Dces epdiUnl ovm WcPMY in any dher If Ye`+. Mfiat muntyl
munry m InCana? r-� .. ri ..
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I/ We certify undes Ne peAalry ot
owner I mntracl buyer of Ne afor
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�ess unpaid as U Mongage / ConVact intlebtedness impaid as af is Ne applirant tlie sde
date of epplKation kg31 of epuitade oxnM
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p Me property in QuesUOn: MnueDy AseSSeE
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the above and foreg ng infortnallon is true and cortea arW Nat Ne applinnt is a resident of Irciiana aM
property on date aDPlication is filed.
of applircant (numGerand sbeet, dty, sfate, antl LP ootle)
PetSOn auNOraed Gy CWy exewted Power d Attomey w by IC 61.1-72-0.7
Pddress of author¢ed person (number arM sbee4 �ry, s+a(e, arM ZIP cotle)
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