HomeMy WebLinkAboutMortgage_McGillema""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year
,..
� FOR DEDUCTION FROM ASSESSED VALUATION ��
Slate Fortn 43709 (f28 / 2-07)
�1 � Prescnbed by DepaAmenl W Local Govemment Finance
NOV g+i6��g
iNSrnucnoNS:
To be !(ed in person or by mail with the CourrtyAuditor of the courrty wheie fhe pioperty is located.
Fding Dates: 1) Real Property: During the 12 rtronths be(we June 17 oJ the year fhe deduction is fo be elfective.
2J Mobile Hames assessed under IC 61.7-7: Aehveen January 15 and March 2 of the year the deductirn i o �
See2versesidefaadditionalinsWctionsardqualifications. GIBSON COUNTY AUDITOR
J I �iiLO —
y as d Marti� 1, airmY',
hare of irrterest?
Nan Ihat ot a icanl, i�
L ��
ct seller
AOtlress of mortga9ce w mntract se
Name of assignce or alher oaner a
AOdreu
�i�ard a.,, V�Mxm i� any au,er
i����
❑ Yes ❑ No
Deduction
20
o(:
%�/��
� —6�tiO�. � —��
aa indewmness �npaid as or nWrh i, �s
numbei arM street, dty. stafe. arrd LP code) / �
%��
U
trty, sfefe. and ZIP rode)
If yes, whal co�mry? Whal Tex
COUNTYAUDROF
�ti�
20 � 20 _
mmeone
spwse.'uWicale with whom.
ar eqwtaMe ownell
❑Yes ❑ No
Is Ihe property in quesUon:
❑ Real Pmoertv ❑ MolHle Hane
fGv nJt Nb �+�e � Cd . —
Dra���er NO��� ........ ,ce,,,,
S51 �N�
Card NO . .......:.....�.....
� 5 7� �8. p°- -
20 20 20
Date (mmfh. day. year)
1/ We cerfify under the penally of perjury that the above and foregoing infortnation is We and corred and tliat the appGcanfs was / were a resident of
tndiana and owner oi tlie aforementioned property on March 1, 20
�nauue (owne� flr�narrre) .. , oate (mmlh. ear. r��
F
aty, state, and LP cotle)
�
by duy e�cewted Power of Altorney ar by
of authorized persm (num6er aM sheeC ti(y, state. aiM ZIP wde)
1 � - � �o - (1
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