HomeMy WebLinkAboutMortgage_Moseby^•+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vea
r__ FOR DEDUCTION FROM ASSESSED VALUATION
� .. �• S�ate Fwm 43709 (R77 / 609)
y,•,. PresaibeE by �epartmeM of Local GovemrtreM Finance
vsrRUCnoNS:
1 Fil a
To 6e filed in rson a b mail with Ihe Coun Audifor or Coun Recorder o/ the coun whe2 the ro � �
P� r h N ry v vem;s�oca�ed.
FiRng Dates: 1) Real Property: Must file dunng the year /or which the deduclion is soughi. f1E t1 unry Auditor
2) Mo6ile /ManuFactuled Homes rrot assessed as Real Property Must i'ile dunng the fweNe (12) months'�' �`� 0�
6efore March 31 of each year the deduction is sought. LJ Counry Recorder
C.�.i —r4—.
See reverse side for additional instructrons and quali�cations.
Apqica f(owner wmnvart buye� - see resvirtions on reverse v0e)
�i ._ _ -fA . w . %a �n �� L. . � GIBSON COUNTY AUDITOR
Tari i�6rct' Keyraan0er/IegaldeSaivUOn / RecorEnumDer Pagenumber
a - _o�-tioi� 000.335-0�8 �,a� 8i
Assastd rahie c( 2a1 yoperty a W Mortgage! Contraa irWebtetlness unpaid as of Mortgage I Contra�Y in0ebtedness unpaid as W Is Ne applttant tha sole
MarU t, ar�rnt year Martl� 7, artent yeer aate ot aOP��^ iegal w equitade amM
r%� ODO ❑Y� ❑No
If no. what's his / her e�1 slure of intemst? If owned vrith someone r ihan spouse, indirate wiN whorn
I/ name on recortl is tliRerent Nan ihat o( apptifant, mAirate Eebw � pie p¢rty �� Q�¢Spp�: q�nually Assessed
Real Property ❑ Armualy Assessed
Name of rtnrtgagee or mno-ari se0er
Atltlress ot mortgagee u contrap seDer (numbe� aM svee4 u1Y, sbte,
w oNer owner or hoitler ot mortgage
Address oyqsvgnee (number arM svee{ tlry, slate;
YT s� � _ o
Ooes epdimnt own yoperty in anY olher
munry in InEana?
❑ Yes ❑ No
approveE in Me amount of:
20 I 20 _
Signature d CamN AuOitar
C .T_
I/ We certify under the pen of perjury
owner I contracl buyer of the atorementic
9gfuA�(oxnerslufreme) n � �
- �.,
rc res. anat muny?
�
`ATat Taxi� Dc
COUNTYAUDROR
20 _
Caunry
Dra�►�cr NO....��f .......
cara �io. ... � 5.�1.
���, aoa.� ........
20 _. 20 _ 20 _
Date (rzmfA, daY. Yea�
the above and foregoing infortnation is true and correct ard �hat the applinnt is a resident of IrWiana and
property on date appliration is filed.
� Date (monfh. daY. Yean
state. and ZIP code)
AEtlmss of author¢eE person (number a� streeL �Y. slate, and LP wde)