HomeMy WebLinkAboutMortgage_Lewis (2)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
-.--
: FOR DEDUCTION FROM ASSESSED VALUATION
• Stale Fortn 43709 (R71 I 609)
S f p�ipep p�, pe�rtmenl of L.anl Govemment Franca
�STRUCTIONS: �
To be filed in person w by mad with the CounryAuditw or Counry Recorder of the county where the property is located.
Fd'mg Dates: 1) Real PropeRy: Must file durirg the year fir which the deduction is soughG I
2) Mobde /Manulactmed Homes rrot essessed as Real Pmperty Must fife dunng the hvelve (12) months �
6efore March 31 0/ each year the deduclion is sought.
See 2verse side /or addifional instructFons and qualificatbn� C
n�fr����lnww�mmnlractbu/E11 te56Cti�rttonrBVe�seSE •
Mmssed value d real PmpertY at d
Mard� i, amenc year
I( ro. wtul ts hit / trer ¢� shara Of interest?
1f name m recoN a diRerent Nan Iha� of app0
� ��a�-ao� -ODI • 4d9-
Fw'Wage / Conbaa 4weCtedrress unpaid as ot Morigage / Con
Mardi 7, wrtent ye{�r _�_� � � date of app4otl
Year
7 n..o('quntyAuditor �
❑� cowty Recorder
GIBSON COUNTY
�����
Yes U No
tl owneA vriN sameore aher ihan sPa+se. iMirate with whom
hMipte 6elow Is the Propeny in 9uestion: MnuaDy Assessed
S I � ❑ R� �� ❑ �,�y�
Moble Fbrt�e OC G
Name W rtwrigagee « mntract se4er
Address of mongagre w mntracl sWer (nursibe� end streel, ray: state, aM i
Name o1 assignee or oNer owner w hdder of rt�ortgage
Ad7res5 of assignee (numDer aM snee4 �Y. �e, and Z/P cade)
Dces applirant ovm property ln any ofher If yes, what munryR
��ry������ n Yes ❑ No
appfooeE u� ihe amwnt af.
20 _ I 20 I 20 I 20
Sigretlire W CounbAUd'rtor I\
I I We certify undes the penalty of perjury that the ahove arW foregoing infortnalia
owner I c nVacl buyer ot ihe aforementloned property on date applicatlon is filed.
Sigr�awre name
x
FWI ' nt dressWapp umbe�and et,dry, , rdLPcade)
04 �
erson auNOrizetl Ey dufy ezecuted Power of y or Cy IC F7.1-12-0.7
person (numberaMS�ee;ci(y;
Has �his dedud'nn been re9uwle0 on property
fo� a^ern v�' n.._ _ n
20_ � 2U_
�I Date (rtmlh. daY.Y��
Ne appiipnt is a resident ot indiana arM
Date (rtmfi. daY. Y�a�
Date (monN, day,