HomeMy WebLinkAboutMortgage_Tuley'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ � FOR DEDUCTION FROM ASSESSED VALUATION
._ � Sta[e Fartn 43709 (R11 / 6-09)
�'` PresoibeE by Department ol tncal Govemment Firence
�+ �w e a
NSTRUCTIONS:
Fwm filed with:
To 6e filed in person or by mail wifA the CounryAudi(or or County Recorder of the counry where the pmperty is located. (�
Fifitg Dates: 1) Real Pmperty: Must file dunng the year for which the deduction is sought. �u�+ �j{�ditor
2) Mobile / Manulactured Homes not assessed as Real Property Must fiie dunng the hveHe (12J months
6efore Maroh 31 of each year the deduclion is sought. C J; ecorder �
See reverse side (or addiUonal instructions arM qualilcations.
nppfuant(ow�rorcontrartbuyer-s�rirsbnsmrevcrses�r�e' ) n_ GIBSON COUNTY AU
Ases�ed �rah�e d real
Ma2fi 1, ar�erit ynar
tt
�
m recad is dfi�t Nan �hat of aPP��L "mCirate belmr.
f mortgzgee or cmtraG seller
Address oT mortgagee or mnbaG sWer (�
Name ot assi9nee or aNer owner or holC
Aildress ot assignee (number antl svee4
Oces applimnt own properry fn any oNer
munry in IMiana?
► ❑ Yes
�- --
Deduction approved'c� Ihe amount of:
er ot morigage —
city. sfate. aM Z/P tode)
�
Page numb�
unpaitl as d I Is Ne aGP�� the wk
iegal w equitaNe ow�mll
❑ Yes ❑ No
rc awrea wim someone an� ma� spouse. i�e��e wm, wnon,
Is Me ProOenY in Questim: M(uiaRy Assessed
� Real ProPenY ❑ ��Y'�
Modle Fiort�e fIC 6
If yes. what mun .�.••,d Ta�g DatriaT Has U�a dedudqn Deen reQUested m property
1 i/ I�^ �. �� tor au�ent YeaR � Yes ❑
No l.,t�-� �
20 � 20 _ � 20
of Co�a:ty Nditw
D,-� �F���- �vo.... a� I.�...... —
c���� �vo. ....3��j....... —
Counry
rte (rtnnth, daY.
2�
1 I We certity u�u the penalry of perjury Uat the above and foregoing infortnatlon is We and wrtect arM iha[ the applirant is a resident of Indiana ard
owner I contraa buyer of the aforemenlioned property on date application is filed.
neaefre lo hdl rarrre� n Dale (rtonN. daY. Yea�
Person aNlror¢ed
ary, state,
by IC 61.
person (number arM sbeet ciry, state,
yea�