HomeMy WebLinkAboutMortgage_Pohl""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
, FOR DEDUCTION FROM ASSESSED VALUATION
Stata Form 43709 (R10 /17-08J
� � Presaibed bY �W ��ent oF Lo� GwemrteN F'var�
INSTRUCT70NS: le 3
To 6e filad in person or 6y med wifi the CountyAWitor d the county where the poperty is located.
Filirng Dates: i) Real PiopeAy: Must lde dunng the year for which the deduction is sought. ��� �� , � n8
2J Mobile / Manulactuied Homes not assessed es Real PropeRy: Must fi1e tlurny the tweNe (12J mon �.xtU arn year
the detluttion is swght
See ieverse side (or adddionaf inshucLOns ar� q�lihcations �y�y � i
wssessee.Aue m�a� aspery as a
� Mamhl.airteNyea .
tl ro. what's h's / hrs exatl share d iNerasll
_ . u rame m remra ¢ aa
Name d mortgagee ar
�.���.� O.C/
iter�le �a�ajpoa, G
( ���o. �3 - aa 8
Matgage / ConlraU indeMedrres unpaid as o( Matgage / Cantraq i
March 1, cvrreM year date oi appl�tion
tl owned v.ilh sartreone aaher U
v� i�dimb bab�'
!� / / � . _ - ' ..
PdErass a mo�igagee «mtlraa setler (nunbcrantl sbmy tifl:
Name d assignea or ofher owner or holAm d moApage
Address d assignee (nurtNOr an0 sbce( l=Y• ffi�. arW LP cad
�,mr � ima�t
n Y�
auorwm m me a�a�m a:
GIBSON
.tXJ�o �G,,
Mnass unpaid as of Is Ihe applimrtl Iha �
legal or equilable o+naR
� � ❑ Yes ❑ No
xsse. irMkate vnfh rMan
Iha 7�W�M in questim: AmwPy Asses�d
] Real Proparty Q Mnualy Asessed _
D,��,,.�r.io.. ab��..... -
� 51��1 �
CAI'(� �r� . ..................... No
couNn wuaro
20 � 20 ZO _ 20 _ 20 20 _ 20
Sipna�ure d Courity Audilor Counry Date l��h. day. yaar)
t I We certify unaer Ne penaity of perjury �hat Ne above and faegaing eiformatbn is We and cwred and ihat the appficant is a res0ent of Indiana anE
owner I�nGad buyer a( ihe a orementioned property on tlate applrcation is filed.
s�o�aw �' : rm � n � o�a r,,,aan. da� .�n
adaress
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atatr�. and ZIP/�de) �
Dale (rtwnN, daY. Y�)