HomeMy WebLinkAboutMortgage_Sexton"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tow
__ FOR DEDUCTION FROM ASSESSED VALUATION
SlatB Fortn 43709 (R71 / &09)
�• / Presaibad Ey Departrtierd o( L.ocal Govemmerrt Flranca
"" File N
INSTRUCTIONS: c� p O 2
To be filed in person or by mail with the Couniy Auditor or Counry Recorder o/ the counry where the properry is Idc�at�d
Filing Da[es: 1) Real Pmperty: Must file durirg Ne year (or which fhe deduclion is soughG �
2) Mo6�e /Manu/actured Homes rrot assessed as Real Prt�perty Must file dunng the tweHe (12)mq�t�s
before March 37 0/ each year the deduclion is sought 0��d"'�
Seereversesideforaddifionelinstructbnsandqual�cations. GIBSON C UNTY AUDIT
AvP� (ownerroontrart buYe see re" m reverse side)
' '/f� DiStriC . � rn��mDet / le9al dCwiG�� Remtd num0er
; rn-idp_o7- o�-oo/. 178-o a-� oo�lo
Arn�sed vahx U� PW�Y as ot Mam7� 1, wfrerR irdebteO�ss unPaid as of aaMongagePP��^ mEebted�xss unG� as of �
A/a(U� 1, aneN year
30 000
tt n0. wtai 5 tus I tcer e�od SI12tB Ol Yfi¢�¢STt -
If rama m 2md's diRereM than that W appEmnl 6idkate bebrr
Name d mort9a9� or mntrsct se9er
i
Addtess of � ar mntraU sWer (r
Name ot astignee or other wmer w hdd�
P.dEress of astignee (numOereMSVea4
Does a�irant own property in any oNn
counry m Ind'ana? ❑ Yes
.:.�:-
� -���
�����
� I/ We cert'rfy er the penalry oi
owner I contraa 6uyer a �he afon
resident address
P4dress ot a�C�w'ved persan
cGy, sbte, aM 21P code)
of rtongage
ry, stet_ 1 and LP catle)
iY-f' .,! . 7
� �—
u yes, �+,a� �
] No
�—
Year
Counry Auditur
Caunry Recorder
P3��
❑ Yes ❑ No
If awned wiih mmeone otMr Ihan spouse. ud'xate wtth wtwm
Is Ne D�P�Y in Guesfion: Mmia�YASSessed
�t� �o�' p a,�n,ao-yw�a
oeoa� r� nc ��.
.�c+�. q Co
�unp? WhatTa�d�DistriG?
zo
that Ne ahove arW foregoing infwmalirn is c
nad oroperty on date apqication is filed.
inJstreef, ary, sfate, antl ZIP
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��eY «a� �� �,.,-,2-0.�
Spye; cdy, sfate. anC LP cotle)
•
�umon Oeen reGUrsted m P�Y
�� ❑ YCS ❑
Dra�� cr \0.....°�D��
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a� 31,�D� ��
- I Date (mwdh. daY. Y��
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