HomeMy WebLinkAboutMortgage_Minnis (7)^`� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__,. : FOR DEDUCTION FROM ASSESSED VALUATION
• S�ate Form 43709IR71 / 6-09)
,,.,� Presoibetl by �ePartmeM of Lo�l GovemmeM Fifance
File Mark
�1STRUCTIONS:
To be filed in person oi by mail with the Counry Audifor or County Recorder o/ the county wM1ern the property is located.
FiI"mg Dates: i) Real Pmperty Must file during the year Por which the deduclion is sough[. unry Fwdimr
2) Mobde / ManuFactuied Homes rrot assessed as Real Property Must file dunng the twelve (f 2) months ���
6e(ora March 37 0l each year the deduction is sought. Recorder
See reverse siQe Ioradditional inshuctions and qval�rations. GIBSON COUNTY AUDITOR
Assessetl vdue cf real pfopeny as W
Ma�d� 1, aam�n yPar
H ro, wha� is his! t�er e:atl share o'�
It nane m remd it 6tfemnt Nan tt
Name of mortga9ea n contract selli
amress m rtrrtgagce or ca,o-ae s
tqss m reverse side)
���a
oter/ �ees«;ptia,
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Mor(qa9e � ca,o-eti Q
Marrh 7, wrtent yeer
of appfranf, uiditaffi bebw
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Name of assignee m�+^-"' /' �\ �
AdEn m'� /✓?S 1 V/.1/-L �.�
�. S��=r- 2� Y
counp
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zo _ � zo
of CamNAWitv
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zo
1140. ��.3-D�b�
Wha,Taritg
ca,nry
someo� other
�b��
: unPalO as ot is Ihe a0d�t Ne sole
�y/� legal w equitable ow+inl?
1/ ❑ Yes ❑ No
indMate xmh �Niom
WoDeM in Vuestion: Mnua�y Asessed
�I PfoPenY ❑ !�!?n!allY A55��
����,�
❑ Yes ❑ No
� ,�
oa�e c�. dar,
Fz��
I/ We certify undu Ne penalry of perjury that the above arW foregoing informatirn is W e and cortect arM Nat the applinnt is a resident of Indiara aM
owner I contracl buyer of the aforementioned property on date application is filed.
imelalb�meh fiN nartml Date (monC�, daY. NBaA
revdem address o( appGCani
autlm�aed
slate,
Attpney or Oy IC 61.1-12-0]
person (num6eraMSbee;ttiy,state,
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