HomeMy WebLinkAboutMortgage_Greenwell (2)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 70
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn 43709 (R11 / 6O9)
�'` y„ � presaibed by DeOa��N of Local Govemmenl Frence
File
INSTRUCTIONS:
Fortn fii
To 6e h7ed in person or by maii vnth the CountyAUdito� or Counry Recorder o7 Ne county where the properry is bcated.
FrNrg Dates: 7J Real Property: Must file dunrg the yrear for which fhe deducfion is sought. A�
2) Mo6de /ManuFactured Homes not assessed es Real Pruperty: Must ne dunng the tweNe (12J months O� "�L
before Ma�ch 31 of each year the deducl6on rs sought �
C . m...-t
See reverse side tor�add"rtional instnictions arM Cualifications.
AsesseE rahs d real P�P�Y az d
M2id� 1, ane1LL ymr
Ii ro. what is his I hu erarl share at ii
tt name m rcmd is E'ifierent ttan tha
Name of mortuacee or contraU seUer
Z�Gnry Aud'ROr
County Remrdu
re� rseside) GIBSON COUNTY AUDITOR
L
KeY number / legal EesniPtian Reco numbu Page nuMei
-/S-ia'-/D/-�/1�60� oia 3���
Mortpage/ 4debted�ress unVaid as W Mor�qaga / ConraC 6NebteAness wpazi a d Is Ne aPW�t tlie sde
Ma� 1, w ^ date ot app�cation legal w equita6le awneY?
OlJ��i ❑vw ❑No
6�E� Delow.
Add(ess of rtnrtgagee w contraIX se0er (nurt� end stree; rdy, state. ard LP cade)
Name o1 assiiFee w other wmer
ACaress or assi9nee
20
— aol �
m�co�,wo�
Mia�a? • • • • •.
D�•�\\'Cl' \� .............
3��a.......
aODroved in the: C:1 l� Cl � O• . . • • . . . • .
—� �So, 3�q• 3�
Is ihe ProOenY in puestion: MnuaOY Assesud
❑ Real RoPertY ❑ �^!��Y �
Wtat Ta�dng D¢IriG7 I Has Nis tleEUaim Oeen 2quested an property
tw a�rem year? � Yes ❑ No
Counry
20
�_ i zo_
1 I We certify under the penatly of perjury that lhe above and foregoing infortnation is We and correc[ arM that ihe applicant is a resident of Indiana and
owner / contract buyer of the aforementioned property on date appliration is filed.
Inature (ownersMlneme) . . Data (monfi. daY.Yaa� �
deN aEtlress of appOCanl (number aM slrae/t/city, slate, eM �ZIP ootle�
�%oi- �Gi1F...�/G �(J/� TJi'f
auNOiaed by duly exeCUted Power of Attaney or Oy IC 67.7-72-0.7
Pdtl2ss of au�horaed person (numberaM stree4 a+Y. stafe, and LP cnUe)
Oare (monfh, day, yEa�
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