HomeMy WebLinkAboutMortgage_VandenBrook.f °•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS en t Year
? FOR DEDUCTION FROM ASSESSED VALUATION �i
Slate Fortn 43709 (RB / 2-07)
�y �.� � Presoibed by DeOartmenl of Local Govemmenl Finance
MAY 1�3�}�
iNSrnucnoNS:
To be filed in person or by mail with the CountyAuditor of the county where the piope/ty is located. � ��
F�ing Dates: 7) Real Property: Dudng the 12 monMs belore June 11 0/ the year fhe deduction is to be eReclive. a�
2) Mobile Homes assessed under IC 6-7J-7: Aehveen January 15 and March 2 0l the year the deduc6on is to 6e'BYfec6vaf
See reverse side /oradditional ins6vctions arrd qualificafions. GIBSON COUNTY AUDITOR
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nc1 � Key mimber / Iegafdesaiptbn Rewrd number Page numbrl
�,,.�� a�-ia-o7-3oa-oo/, 3a9-o�8 �Oc�`t o0
ahre ol real paperiy as of March 1. airenl y�r Mor(ga9e I ConVact indehledness unpaid as of March 1. is Ihe app6mnt Ihe sde legal w eq�ritade (
wrtent year I� D 0� ❑ Yes ❑ No
is ha / her exaa share ot inieresl? If owned wiU� someone oNer Ihan spouse, �cate wiN whom.
If name m recad is ditterent �han
Name o( matgagee or conLacl
mortgagee a
o( assgrree w oihe� wmer a holder af mar�gage
Address o1 asvgnee (rn�rt�6er aM sLeet
Dces applicanl wm propeny in arry oNer
counry in Intliana7
❑Yes ❑No
Deduction approved in the amount ot
20 � 20
iWre ot Counry Audrtnr
eet. dry. sfate, anO Z/P caCe)
LP oode)
If yes, what counl� Whal Te
couNrrnuoiTo
Is I�e property in quesUon:
❑ Real Ptoperty ❑ Mobile Home QC G7.1
�l.o.�.-��(-o�o-C-'�OS - �
'_ �)1':l\\'CI' ��.�oY.,/ c.• ��
� v�m
�� ❑ No
C�ll'(� �� . ........:...........00
�y;�`%��'�iso �.
2p _ I 20 � 20
Ca�nty
20 � 20
day,yea�
I I We certify under the penalry of perjury that Uie above and foregoing infortnation is true and mrred and that the appticants was / were a residen[ of
Indiana and owner of ihe afwementioned property on March 1, 20 _ �
Person
a by IC 61.1-12-.07
persm (numbei aM strce; dty. state, arrd
Da1e (monN. day. yea�