HomeMy WebLinkAboutMortgage_Ortiz (2)".� °^� STAIEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Form 43709 (R8l 2-07) { � ��i �
�' � Resmbed by DepaNnenl of Loral Govemment Finance �L/
�NSrnucnoNS: ���`� 2008
To be filed in person or by mad wiU� the CouMyAuditor o/ the courtfy where the p/opeAy is bcated. -
Fding Dates: 1) Real Roperty: During the f 2 montl�s before Jurte 17 0/ the year fhe deduction is to be elfective.
2f Mo6tie Hwmes assessed urMer IC 6-7.1-7: BeAveen January 15 and Marcfr 2 of the year tf�e deduction is to be �, ,Q�
SeereversesMeforadditionalinsWCbonsandqualifications. GIBSONCOUNTY �ITnR
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see res4ic5ons �rerer� side) ,
Key mimber! legal descripy�i D� '/O "'(% D�, �7O 'OeZ R��a/' i L/ P� � LJ�
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real property as d Mardi 1. aeienl yav MMga9e / ConVact indeWedness un{raid as of March 1. Is Ihe applimnt Ihe sole legal w equiUble avne(
artenlY�
7 S/Ya7� ❑Yes ❑ No
,��sc^.,.J
If owned wGh sorrieone oiher Ihan spouse.
eppiicanl, indicate balow.
Name of rt�gagee or witract sdler
Address ot moAgagee « mntraa sellm (numbu and s
Name of assignee or alher wvner rn haldar of mortg�
nea�ess or �y�e (MUr,be� a�a srre�t �A: s�are. ar,
Dces applirarrt own praperty in arry olhm
cauNy in Indiana?
❑Yes ❑No
Oed�tmn appmved in �he amourri of:
20 � 20
SigraWre of County Auditar
sfate. and
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��� �n�
��,�.�l /0.�(�-08'
�� Q avo�_ s�So
�'��; oUO. co
20 _ I 20
Counry
Is Ihe propeM1y in questim:
❑ Real P�operty ❑ Modle Hort�e pC 61.
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Has Uds dedudion been reques�ed on poperty �
for current yraR �
�, ❑Ye5 oNa
20 � I 20
(month. day,Yea�
20
I! We certify under the penalty of pe�ury that Me above and foregoing information is We and correct and that tlie appfidnfs was / were a resident of
Indiana and owner of the aforementioned property on March 1, 20
I��Suf (owners h�fame) �. ._L .
Date (mon(h. daY. Y��
cdy. state, and ZIP oode)
�.iiii� .�i -
ezewletl Power of Attomey a by IC
Address of auUmrized persm (num6eraiM
Date (mmfh. day, yea�
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