HomeMy WebLinkAboutMortgage_Perry (7)�,a�^Yny STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
�i� , q FOR DEDUCTION FROM ASSESSED VALUATION
%� ��` State Fortn 43709 (R71 / 6-09) Sl 2012
"�:�'', Presabed by Department of Lowl Govemment Finance F��
a. i
INSTRUCTIONS:
bJ
To be filled in person or by mail. po� ed with: �
Filing Dafes: 1) Real Property: Musl be completed and dated in fhe ca/endar year for which lhe deduc6on is soughL O C T j b�2
Must be !!ed with the County Audifor or County Recorder o/ the county where the property is located County Auditor
on or before January 5 0/ fhe immediately succeeding ca/endar year. C. J, i'�..�. — County Recorder
2J Mo6ile / Manufaclured Homes not assessed as Real Property: Must fle with fhe CountyAuditor of the (\�
county where the property is localed dunng the hvelve (72) monlhs befo2 March 31 o(each yea� the "
deducfion is sought. GIBSON COUNTY AUDITOR
(ownei or confract buyer- see restnctions on reverse side)
Perry
ssessed value of real property as of
arch 7, wmem year
no, what is his / her exact share of inter
name on record is diftereni than that of
ame of mortgagee or conVact seller
erman American Bancorp
idress of mortgagee or contract seller �
11 Main Street, Jasper, IN 47577
ame of assignee or other owner or holdi
applicant own property In any other
y in Indiana?
❑ Yes I
ction approved in the amount of:
20 _ 20 _
Key number/ legal description 26-18-13-403-000216-026! Property
207 N West Street Fort Branch, Indiana 47648
PIN
26-18-13-403-000.216-026
1, curtent year
yes, �
�
as
applicaGon
someone
_ — . .
��/ 1 � /
Dra���ci- NO...°�O.�OZ........
C:n'd \O. .....�J.�.�.........
20
20
031�/� �S�
�debtedness unpaid as ot Is ihe apP��ni ihe sole
legal orf quitable ownelt
[�Yes ❑ No
i spouse, indicale wi�h whom
properry in question: Annualty Assessed
>.al Property ❑ Annually Assessed
Mobile Home (IC 6-1.1-71
ias tnis aeoucuon oeen requesteo on prope
�or current year?
Yes ❑
20 � 20
I/ We certiry under penalty of perjury ihat the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of ihe aforementioned property on date application is filed.
resident a�ress o� nt (6um6ei nd s
N West Street, Fort Branch, IN 47648
or
person (numDe/ antl StreeL
- % ti - / Z
day, yea�