HomeMy WebLinkAboutMortgage_Miskell (9)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS - u o s' Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION �
� Sfate Form 43709 (R71 / 6O9) -
�,µ Presoibed by Departmen� of Local Govemment Friance
�NSrRUCnoNS: FUG 29 2��Ma`�`
To be filed in person w by mail wifh Ihe Coun Auditor or Coun Recorder o/ fhe coun where the m� ��
b b �Y v�aem is �ocared: -
Filrng Dates: 1) Real PropeRy: Must file dunng fhe year for which Ihe deduction is sought. Counry Auditor
2J Mobile / Manufactured Homes rrot assessed as Real Property: Must file dunng the twefve (f 2J months
before March 31 of eacli year the deduclion is saght.
GIBSON GOU TY 1�19P�bR �
See reverse side for additional instrucUOns arM qualifications.
APP��t (owneror contrarl buyer- see 25lnc0aa m reverse stle) _ _
�
7-/U�„�w a -�a-o�-d��-m�.siy-
Asessed �ah�e oF2al PoP�Y as W ge/ Contract Irde6tedrress unPaid as d Mort
Mart� t, mmnt year Ma 1. artem yenr date
11 ro. what is his / her exaU share af interest? K owned wiN :
If name on �emrd 5 diRerent than Nat ol appG�ant. Indifa[e belmr.
Name of mortgagre or contrarl seller /' /^ \ /�
u ��:;;
Add2ss of mwtgagee a mntrad se�er (nvnbar and sfree; cdy, state. anC LP code)
Name of assignee w otlrer owner w holtler of mortgage
Ada�ess ot
diranc avm pmperty in any dhp
Ind��ana? ❑ Yes
ueouam approvea m u�e amoum or.
5)etB, erM LP� e) n�
��
� If yes, wha �np?
�r.
What
COUNTYAUUI
Reto(d number Page number
�8 0 �' yr3
/ Contrafs uMebtedrress unGad as d Is Ne ePG�t the sole
�p 'on legal w equitade awnM
— O D .O ❑ Yes ❑ No
o�re othar t an spouse. iMrcate with whom
�I tlre mperly in OuesEm: MnuaM AssessM
Real Properly ❑ Mnually Fvsessed
MobBe Home (IC 6
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. ��y �
Dratiti�er i\`0�...,°,�� lo`�
Card i1'O. .. 3�� 3
Y
20 _ 20 20 _ 20 20 _ _ _ _ _
�rature,Qf CambAWitur Counry Date (monp�, daY.Y��
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C I
1 I We certify under Ne penalry of rjury that the a e and foregoing infortnalion is true and cortec[ arM that the applinn[ is a resident of Indiana arW
owner I contract buyer of Ne aforementioned prop rty on date applin0on is filed.
)9yure (awners fWl nainU .... '/J Date (month. daY. Y��)
eM LP mtle)
puson (num6eraMStreeLm3:5fate,andZlPCOde)
Date (month. daY Y��)