HomeMy WebLinkAboutMortgage_McEllhiney (6)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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FOR DEDUCTION FROM ASSESSED VAL�� ��
• State Fortn 43709 (R7116-09)
� � P�esaibetl by DepartmeN of Local GovemrtreN Fnarr.a
`-3 �� File Mark
�srRUCnavs: (1[(` �� (1t1
be fiied in person w 6y maii with the CountyAUditw or Counry RecoNer of the cddlH}�wHE� t�pkperty is located.
F�Ting Dates: 1) Real Property Must file dunrg the year Po� whirh Ute deduction is sought.
2) Mobi/e / Manulactured Homes not assessed as Real Prt�perty Musf.fileldarirg�e.lwe� Ne (72) months
before March 37 o(each year the deduclion is sought �V �\
See2versesidetoraddiCana/in�rucwnsandy�a�ations.� _ � GiBSONCOUNTYAUDITOR
AppGrant (owne� or conhaa
� ��
ws��ed .ap,� of re� n�y � a
Ma�rh 1, amPnl yrdr
If no. Wha� h ha ! her enatl share ot inte�esl?
It name m recpd's dAferent lhan Nat ot aPpl
Name W mwtgagee or mntraG se�er
�-c�D�-OG�•
Contratt'uWebtedrress unvaid
Address W rtortgagee or contrad seller (nurriber and svee; cdy, state, ard
Name of assignee w other owner or holder of rtnrtga5e
AAtlress o( assignee (number and strce4 cay. sbte, and ZIP code)
oxn p�operty in any Wnu
It awnetl wiN someone aher Ihan
VYhat Ta�otg Dist+ic[?
Fortn filed wBh:
�County Auditor
❑ Counry Recorder
RemN rju br1 Pape num0u
( �
btedness imR� as d Is Ne eVP�t ttre wle
Iega1 p epuBdtle awneR
❑ Yes ❑ No
spouse, iMicate wiih whom
Is Ihe property in QuesUon: MnuaOy AssesseE
❑ Reai a�oaenr � nm,uaiy w�ess�
Has �his tleCuUim Eeen reGUesced m G�DeM1Y
for artent yeaR �.. �
COUNN AUDROR
Detludion approved in Ifre amounl of:
20 20 20 20 2q 20 20
Signature ot Crnmb nud'rtcr Caunry Date (manrh, eay, Year)
I/ We certify under the penalry of perjury ihat the above and foregoing infortnation is true and cortect and Nat the applinnt is a resident of Indiana arW
owner I contrad buyer of ihe aforemen6oned pmperty on date appliration is filed.
' atu ow�¢!s (WI me) Date (monN, day, yeah
L< ��
' ent adtlress d a I(nu� r ntl f. ty, State, and Z!P e), /
/ , �� Lc. , � � 7�
Person au�M�rzed Dy Euy exewceE Power UAnuney or by IC fit.1-72-0.7 Date (monm. tlay, ysa�
PCdress of aWiarzed person (numDer a�tl sbeet, dry, stafe, antl LP code)