HomeMy WebLinkAboutMortgage_Leffler.P °� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R8 / 2-07)
S mu f Pr�rnbed M DePanment of lacal Go�emmein Firw�ce ��}'
�. _.-...File'.MS?rk' .•
/NSIRUC710NS:
To be filed in person or by mad wifh the CourttyAudifor o/ the county where the property is bcated.
Fd'arg Dates: i) Real Property: Dunng Ure 72 mon�s before June 71 d the year [he deduction is to be elfective. O C T < U ( u U 0
2) Mobile Hames assessed urMer IC 61.7-7: Betxreen January 15 and March 2 0( fhe year the deduclirn is to be effective.
See reverse side /wadd� I insWctions aM qualificafi^ . ��-�..�
!% :�a�. : %,:',L. .
Key mimba
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If reme m record is Eifierenl Uiar� ihat oF applicara, i��le beloa:
Name of rrongagee or canLaG saller
amess m�„oneayee «cmvaa sd� (�,rt,ea` and meec dry. srsre. and
«dher o.vrrer w hddar d mwtgege .
ot asvgnee (rni+Mer aM s6eet. tity. sfete.
Dces applicant ovm poperty in arry olher � If yes.
counry in Indarm7
❑Yes ❑ No
G�BSON COUNTY UDITOF
Reoortl numbei Page rwmber
�3d —d 2�' 0� S�
���o,��,,. �s�,e�m,���e���a���e��,
� ❑ Yes ❑ No
med wdh mmmne alher �han spouse, mdicate with whom.
NRiatTa�dn9 District7
Is ihe property in question:
❑ R�I Pmperty ❑ Modle Home
requasted on property
❑Yes �No
�wer Na 'R
duction aPProved in Ihe amourrt nIn �oO _ �/� �/
�� .... ............. �T
�p � Zp _ n/ f/� . �/ 0/ � QQ . U u 20 20 20
Q/�V ��
e nryluidMr County Oate (monlh, Oay, yea�
I/ We certi . under penalty of ury that the above and fwegoing iniortnation is We and mRecl and that the applicants was / were a residenl of
Indiana and owner e aforemen6med property on March 1, 20 _ __
addres: of
Person autMr¢ed by
cdy, sfate. ana
w by IC 61.142-.07
pellsan (nvmberandsfree4 dy, sWte. and
1:
Daie (mmih. day, yea�
.in_ �i_.�a
Date (rnonth. day, year)