HomeMy WebLinkAboutMortgage_Martin"'� STATEMENT OF MORTGAGE OR CONT�Z,i��� Coun Township vear
�__ ; FOR DEDUCTION FROM ASSESSED V A�I N
State Fortn 43709 (R71 / 6-09) 1
�' ,,,� d Presaihed Gy �epartment ol Local Govemrtrenl F�nce
wsrRUCnoNS: APR 2 7 201I File Mark
To be filed "m rson a 6 mail with the Coun Auditw or Coun Recorder of the un ere the ro FO� �� �'
PQ Y N N Ba�p�P PenY is locafed. \�
Filirg Dates: 1) Real Proparry: Must file during the year /or which the deductl6n � �CJ/ Counry Auditor
2) Mobde / Manufactumd Homes rrof essessed as Real Property: Must file d tweHe (12) months /��
before March 31 of each year the deduction is sought. ❑ Counry Recorder
See reverse side (a additional instructions arM qualificatbns.
GIBSON COUNTY AUDITOR
�l AlAAIlX buyer. ��rewrseside) �
OO l%1 / ,G!/2.�0 �OA /N �
'i TaPng�sgiU_ Key number I kgal d ' tion � ° R¢miq pumper Page numba
fl[:Fi:-'i�.Y's �
tYJ . � -Q � cY � �
act irdehtedness unpad as of Mw�gage I ContratY iMe6tedness tmpaiE as of Is Ne epp�tlni the
year date o( app6ntion kgal w equipde owndi
❑ Yes ❑ No
I( m. what ¢ his / Iwi e�mct share ol intrlest? �f awned wiN someone other tAan sP��. Indimte wuh whom
It �wrie m remrtl's difteRnt Ihan fhat o( aPP�4 uM'xate below. Is Cie property in Ouestion: Mm�aM Ass¢sed
eaI Frovenv ❑ ��N Pssessed
__ _ .- MobileFWnepC6
Name ot rtrutgagce or crnbact se4er � n ' I �
� (��u �t* � �- �3
Address of matgagce or mntrad seArs (mm�6er end streeL ciN slate. an rn � /��� �
Name af assignee w oMer mmer or holder of mort9a9e ��1 `� I
(number aM stree4 ary, s+ate, and Z/P code)
voperty in any olher If yes. whal munt�!
20 I 20 I 2Q
I I " 1��2.
)UNTYAUOROR
20 20
ihis dedudion Eeen requestetl m p�operty
urtent yeaR � Y�
❑ No
20 I 20
I I We ceNfy unAer Ne penalry of perjury that the above arW (oregoing in(ortnation is W e and cortect arid Nat the appli�ant is a resident of India� arni
owner I contraa buyer of Ne aforemeMioned Droperty on date application is filed.
�^aw.4� (pp^e/s j�➢^smI) . � Date (monN. daY.Yae�
esecycetl
and ZIP code)
of Attorney w by IC 61.1-12-0.7
person (numDerantl sbeeL cily, state,
Oate (rtmN, tlaY• Yse�