HomeMy WebLinkAboutMortgage_Payne (6)_""� STATEMENT OF MORTGAGE OR CONTRACT IND��FgSS 7ownsnip vear
: FOR DEDUCTION FROM ASSESSED VALUATION rn
-. � Sta[e Fortn 43709 (R11 / 6-09) YJ
�` Presaibetl M Departrtierrt ot tnd Govemmem Finance
wsraucnoNS: MAR 1 O 2011 File Mark
To 6e filed in person a by mail with fhe CounryAuditor or Counry Recorder ol the wunry where th&p ' Ocated. F� fl� ��
FiHng Dafes: 1) Real Pmperty: Mus[ file dunng the year for which the deduction is sought. C�� Counry Auditnr
2) Mo6r7e / Manufactured Hanes not assessed as Real Prt�perfy Must h7e during Me tweNe s
befo�e Ma/ch 37 of each year Ne deducton is sought County Recorder
GIBSON COUNTY AUDITOR
See ieverse side for addilional insWCtiwis and qualificatrons.
' Oistrirl Key numder / legal desaiption ' Record num�r Page ry�mb� �
r�� r� ab-I a-o�-I oa-boo, a9 9-ba� �� id �
Ass�sseC value dreal qopvly as oi Mor�gage / Con G Intlehtetlness unpaid az of Martgage / Contract iMeMedness impaid as d Is Ne epplkant Me sde
'&1ard� 1. aarerrt year Mart�h 1, a� --/c � Eafe of aPP��� legal w equltable oxrre!?
1 1�t'O O ❑ Yes ❑ No
If ro. what Ls his I her e�ct sha�e oi interesl? H avmed vrith someorie other Nan spouse. indxate with Mtnm
tl nartia m remrd is dMerent Itwi Nat W aDG�l'oi0irate Debur. Is ihe V�P�Y in Vuesoon: MmieM Assessed
� Reai P(opefty �lVmuallyPsessed " ' '
Wme of rtnrtgagee «
nca� a � � mno-au
city, stata.
wR
D,�1�,��,� �io...:. � �1......
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� `� �a 7, `l`tj�. �O/
DeEudion approved in ihe amwnt oE
20 _ � 20 _ � 20
Auditcr
RII�71L7:1
20 _ � 20 _
Counry
I I We certify undes the penalt�of perjury Mat the at�ve arW foregoing infwmation is We and cortect
owner I mntract buyer of the at«ementioned proper�y on date application is filed.
Pason authorizN Ey Outy ezewced Power al Auomey w by IC 61.1-12-0.7
o( autharaed persm (numDererM sbeef, crty, state.
�f?67o
Has ihis deductim been ie7uested an propaq
far a�rent yraR ❑ Ye5 ❑ I
� I �—
���` O�c i0—�I
the applinnt is a resident of IrWiana and
Data (norsth. daY. Y��)