HomeMy WebLinkAboutMortgage_McGillem (10)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u' hi Year
s FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fwm 43709 (R77 / 609)
��.�. � PresaibeE M�G��M a( Lod Gavemment Firiams
APR 3F�#
wsrRUCnoNS:
F«m maa w�m:
To be filed in person w by mail wiN Ne CountyAuditor or Counry Recorder ol Ne counry where the properry is located'-yy�
Fifirg Dates: 1) Real Pmperty: Must file dunrn,7 fhe year /or which the deducUon is wught. p�! un Auditnr
2) MobBe / Manu/sctured Homes rat asseued as Real Prt�perty Must file dunrg the twefve (12J months h
beiore Ma�ch 31 of each yearthe dedudion is swght GIBSON C UN� ABOI'i�R��
See /everse side for additional instruclions and que/ficafions. „
�
d vaNe d real pfapeny as of
7, ca�rnt yrdr
no. what k ha / tcer emtl shara ot Nterest?
_o � 03-0�%9 7•o�b� Dl
age/ Contraa intlebtedn�s unPaid as d Mortgage / Cantraa 4iCebtedness unpaiC aa of Is Ihe eV�t the sde
7. curterrt ynnr tlate of aDPGptio^ kgal or eWitade oMnCl
v ❑ Yes ❑ No
If ownad wiM sortiearre aCier Nan spp�se. md�ie with Mqm
tl name on'emd is Grtterent Ihan Nat o1 aPP��t'mCipte Oebw.
Name ot nartgagee or mntraa
or holder of mortgage
�:
(number antl sheeG �Y, s�+e, erd 21P rotle)
Does e�i�m wm praperty in a(ry oNer
counry m Intliana? I"I .,' _
oeaua;a,
20 _ � 20
Sig'a9ae d C(amb Auditcr
I I We certify under the
owner I tontract buyer�
inauug (oxmis f� rrame)
i, yes. ,.,ai c��ryr � v�i,
�
�
ry ot perjury Mat the
afwemen0oned Wo
ezecute0 Po�rer
PdEress of auMu¢ed persm (num0er aM sbeet �y, sbfa.
20
perty in Que5lion: MnueDyASSessed
ProPertY ❑%vmually�
llra��'Cr NO.... ��.� D......
Card \'O. ..... .�.�-.7.......
��i� �
�— � p—
Date (rtroNh. daY• Y��
�
�
❑ No
e arW (oregdng infwmation is We and mrtect arW thal fhe appiirant is a resident of IrWiana and
on date application is filed.
. Date (rtm�, daY. leeA
61.142-0.7