HomeMy WebLinkAboutMortgage_Victorry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T Year
__ : FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R71 / 6-09)
� Presaibad by DeparlmeN af Lnml GovemmeM Fu�ance
�w
F'
INSTRUCTIONS: AP
To be filed in person w by mail with the CountyAUditw or Coun Recorder of fhe coun where the m F� �� ��
Fiing Dates: 7) Real Propeily: Must file durirg the ry ry P�M ����
year fir which the deduction is soughL C���ry q„d,��
2) Mobde / Manufactured Homes rrot assessed as Real Property Must fiIe dunng the tweHe (72) months
befo�e Maich 37 0/ eacfr year the deduction is sought. ry Recorder
GIBSON AUDITOR
See reverse side for addilional instnictions aM qualifications.
Ap nt (owner armn4act 6uyar- see restrich'ons m raverse side) V�
Ta Distria KeY �/ kgel desaiP� RemN num0er Page numEa
� i�i��� -o �-30 -ooi /3/ -oa-d' o �� 7
IAssessed vaLc d mal poperty as ot Mwtpage / ContraG iMebteOness unpaiA az of Mort9age / ContraG udehtedness �speid a d Is Ne epp�rani ihe mk
Mamh 7. aneM Y� MarU 1. w � Eate of aPP�� kqal a W�itable ox�rce(1
, �v J, OO � ❑ Yes ❑ No
f3z-:
If name m recatl a CAterent Nan Nat of apPaan; c�EiUte h¢Ww.
Name of mortgagce a mntrari se�lu
AGd�ess d rmrtgaqee or oontraU s�er (nurNr� antl saeeG �'. sbte.
Name of assignee w Wher owner or hdEer of rtprtgage
neeress
saee4
Dors appi�anl onn G�D�Y in any other
taunry m InCana? ❑ Yes
❑ No
Deaucfion approved'e� iha amount af:
20 _ 20 _
Sig�anneWC/rnJmryAWitcr �
i • � •
I/ We cerUfyy�Q er Ne penalry ot perju
owner I c �rifrac{ 6uyer of the aforemen
Sq hA .
ru0 retid� dres of eppGrant (nu ard �tre
U�
�
Persun authorized by Euy executed Pov.er ot Attor
� �
If yes. what munfy�
20 _
the aO bo�• f
ProGertY da�
r
L
ity stat� we:a�LP
,�.wi �—
w by IC E1.1-12-
20
someo�re Wher �han wouse.
Is Ihe property in quesYbn: MnuaOy Assessed
� Real Property ❑ Mnually Assessed
MobBe Fbme !IC 61.
W�a� Taring D'str'vi?
Dra�ver NO.......� �. ......
N
,�oROR l � �' �
Card 1\'O: .. .. ......
_ 20_ - I,IO���I I . UV
regoing infortnauon is true and cortect arW fhat the appli�ant is a resident of I�iana aM
applicabon is filed.
Date (montfi, dfi:Yaa�)
pers�u� (numberaM sbae; dry, stale, and LP code)
�iYerar..r _ ._ _ _ -"'""""'"'""""""""'_'__"
Date imonlh, tlzY. Y��