HomeMy WebLinkAboutMortgage_Thebodaux. , _ . .. . . -. . . ' + _ � � i
.e=,•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE� �Coun . -t�i'amship Year
�,, . FOR DEDUCTION FROM ASSESSED VALUATION ��y� g�;
State Fam 43709 (R8 / 2-07) 1. i.�'
��� Presaibed by Department of Lacal Govemment Finance ,
N�V 1 9�UU� File Mark
INSTRUCTIONS:
To be (!ed in person o� by mail with fhe CountyAuditor o/fhe cowty where the property is located. � � .
Filing Dates: 1) Real PmpeAy: Dunng the 12 months be(ore June 11 0( fhe yeai the deduc6on is to be eflecG-ve�� ��,y�
2J Mobile Homes assessed under IC 67.7-7: Behveen January 15 and March 2 0/ the yea� the�deduction is to be eflective.
See reverse sidelor edditional instructions arrd qualifications. C�IBSON COUN7Y AUDITOR
Applrcant (owner w m cf 6uyer - sEe resfricfions on)eYerse �de) �
DisUiQ
Assessed �ue of 2al poperty as of
reme on
Name of mortgagee or cantract seller
(ey num6er (legal desaiplion
,�a.n�-uni_
of mortgagee a tantrdd seiler (num6er end
Nartre of assgnee a ather owrrer a
own poperty in eny other
m,
❑ Yes ❑ No
Deduction appmved in �he amount
�
Sigreture of Counry Aud'Mr
�
sfate,
vv�•���vo•u
/ Corija{.4 indeWedness unpaid as of March 1,
o�� ����
����V���
����-S-s�7
eu _ � 20 _ I 20
County
Remid numDer
« equnade rnmer�
❑ Yes ❑ No
spouse, indicate wiN whom.
Is Ihe property in question:
❑ Real Prooertv ❑ Mobile Home OC 61.
20
oate (month. aey,
❑ Yes ❑ No
20
I! We certify under the penalry of perjury that ihe above and fwegoing intormation is true and corred and that tlie applifants was I were a resident oi
Indiana and owner of fhe afwemenboned property on March 1, 20
�nawre awr'ars rwinamel Dale (mmN. OaY Y��
� r�sidenl address of applicant (n
P n aullror'setl by duty ezacuted
Addrass of aNhor¢ed person (num
Ntomey or by Ic
eM Zlf mtle)
oa� (�m. mr. r�d