HomeMy WebLinkAboutMortgage_Stamper"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T n vear
-r=--
; FOR DEDUCTION FROM ASSESSED VALUATION
. Sbte Fartn 43709 (R71 / 6-09)
�' ,,,, P�awibetl by �ePartmeM of Laal Govemmenl Fi�nce
tle
�vsrnucnoNS: MA �1`�`Z
To be filed in person or by mail with Ne County Auditw or Counry Recader o! the county where tAe properry is located. Form med wim:
Fding Dates: 1) Real Pmperty Must fJe durirg the year (w whicA Ne deduclion is soughf. C� � n Auditor
2) MobBe / Manufactumd Homes rrot assessed as Real Property: Must Ae dunng the fweNe (72) rtanths ry
before Ma�ch 31 of each year Ne deduclion is sax�ht. Recorder
GIBSON OUNTY AUDI OR
See 2verse side (or addition�Ljesfructions and quali�rcafions.
AppGCam (owner or mnvad b r- _ resvi�ans m mvers�Ade) �
KeyrWmber/I aldesaip.
��_ _i�_n�"_�n�-
w���r�w�y�a
Ma�M t, aaren[ year
II no, what is his / her e�mU share ot inV
It rartre on n,md is tlilferent than Ihai c
Name ot mortgagee m mntrarl seller
Add�ess U mortgagee or mntract se�er
Name of assignee w aher owner or hd
Page
/ Contraa inde6tednPSS unpaiE az of Mortgage / Contract'u�debtedness unpaid az d Is Me eppGrant Me sde
v�r t ye�ar�('1� date of app6cation legai w eQUiHWe ovme(1
`% /J(J[/ ❑ Yes ❑ No
uMMicate Oebw:
nwrtgage
5fafe. a/ \
Does apptimnl ovm praperty in any oNer
munry in Ind'ana?
❑ Yes ❑ No
Deducfion appoved in Ihe amounl of: .
20 20 20
sigianue of Camb Aue�nar
ri(y, sta:e, ard LP code)
If ovmed wiN someo�re other Nan spouse, iMicata with whorti
Is Me P�PertY in QuesOOn: Mnually PssesseE
❑ Real Rovertv ❑ nm,ualy assessed
Modle Fiortie (IC 61.1
I
Di•a�ver NO.... �............
590.3
Card NO . ...................
��5, ►a7.� �'�`a°
20 I 20
� Ihis deduction been reVuested m P�Wg�Y
arrent yeaR ^ _ _ rf
20 I 20
I/ We certi(y uMer Ne penalry of perjury that the ahove aM (oregdng infortnation is W e and cortea aM iha[ Ne appiu2nt is a resident of IrWiana and
owner I contract Duyer of the atorementioned property on date appfuation is filed.
�rc�lu o fiIDname) � / Date(monlh.day,Yean
esecute0 Power of Attamey m by IC 61.1-12-0.7
Address of author'ved person (number a�M sbee; cify. state. aM
Date (rtaonN. GaY. Yaall