HomeMy WebLinkAboutMortgage_Umpleby'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o n Township Year
_ • FOR DEDUCTION FROM ASSESSED VALUATION
�. ..• Stale Form 43709 (R71 f 6-09)
� F P�pyd p�, pe�nmynt of LoW GovemmeM Fnanca
File Mark
�srRUCnoNS: MAR 2 0 ,w;tl„
To be fifed in person w by mail with the CountyAuditor w Counry Remder of fhe counry where the pmperty is located.
F7tig Dates: 7) Real PropeAy: Must file during the year for which Ihe deduction is mughL C.'�. Counry Auditor
2J Mo6de /Manufactured Homes not assessed as Real Properly Must file dunng the twelve (72) months
6elore March 37 ot eacA year the deducfion is sought County Recorder
See reverse side lar addifional instructions and qualificafions. GIBSON COU
M (owneraroontraRDuyer-�reeies4irbonsmreve�eside) ., l n n . _
Ta istri(i , �K�
A�eO vdWe dmal propertY as W
MBiM 1. daretrt ytlr
If m, wfiat Is his I her erar� share of intei
If name m remrC's diftuent tlun tlat af
Name of mwt9a9ee or mntratl seller
r,�� or ��� «��a �e� i
Name of assignea or othu owner or hald
Atldre ofasvgnee(numbaraMSVee4
Dces a�i�ant rnm poperty in an Ne�
munry m Indana? ❑ Yes
�
I
DeCumm approved'v� Ihe amount ot
Ci5
mber / legal EesafD�on � � � �/ Remrd rnimber PaBe numErl
_ o�{-003. 83�-0�8 2�olY D,�
Mw(q'age/ Contract irWebtedness unPaitl as of Mongage I f.ontraa mdebteEnrss unPaid as d Is ihe ePW��� Na sole
Mamh 1. artent year Eate o( aDP��^ [% D D D �I w equitade awne/?
v ❑ Yes ❑ No
If awned with someo� otl�m tlan . iMimte WM whom
rant, rtd'uate beb�r. Is U�e D�W�rtY in 7uestiorc Mrn�a➢Y Assessed
❑ Real RoPeKY ❑ ?±�!�M � . . _
� ar�c �eeec �: �.
rt�ort�age
slafe, aM Z/P tode)
If yes, whal Co
No
20 — � 20
I I We ceRify under Ne penalry of perjur�'Mat the
owner / mntracl buver of the afo2mentioned pro
app�cant
auUrorrzed W CuIY ezecLted
��I'�.G'SL
iverKf Attomey or by IC G7.
and sbee{ city, stdte, an0 2
6I�III�i\'Ll11�Lt1.
20_ � 2q_
_ _
Drawer i\'0...�Q�c�.....
Card \'0....��ds
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,._.�8i�. �
20_ � Z�_
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toregoing infortnation is W e and cortect arM that the applirant is a resident of indiana arW
te applicatlon is filed.
Date (nmih, day, yae�
- ��G�
Oate (monN. daY.