HomeMy WebLinkAboutMortgage_Sumner (2)"'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R11 / 6-09)
�,� 1 PresoibeE by Department of Lorrl Govemmenl Frerce
INSTRUCTIONS: �
To be filed in person or by mail with the CounryAuditor or County Recortler of tAe county where the p�operty is located.
Filirg Dates: 1) Real PropeRy: Must file during the year for which fhe deduction is sought. �
2) Mobile /Manufactured Homes rrot assessed as Real Properry: Musf fi/e dunng the hveNe (12) monfhs
bePore March 31 of each year fhe deduction is sought.
See reverse side for additional instructions and qualificafions. C
App(vant,(ownerpr contrart buyer - see restpqfiore rn reveryE side) 1
f' <o- _ 4- lol -DO/. y
Asessed vahie of eeal as o( Mortgage / Contraa iMehtedness unpaid as of Mon
M2�M 7, nuren[ year Martli i. artent year date
If no, what is ha / her exact sha2 of interesl? If ownad with �
If name on �emitl is dA(erent Nan Na� o( appGcant, uWicate below.
Name ot mortgagee or contracl seller A � ' �^l/
YJ"l� '—w
Address of rnortga9� w mntracl seDer (num arM ; cify, stare, and ZIP code)
or dner owner or naaer ot mortgage
MOmss ot asvgnee (numcer ano suee4 �: s+afe, aiw ur cooe)
Dces applicant own property in any oNer If yes, wha[ wunl�/7
munry in IndFana? n.,_ _ I"I .. _
20 � 20 � 20
WhalTadrg C
��Yp/ry� Auddor
OUnly Recorder
GIBSON COUNTY AUDITOR
Remrtl number Pa9e numbrr
.0.2% I % `t(0�...3
itra�Y indeUteOness unp2d as of Is ihe appGrant Me sole
tion legal or equitaWe mmeY.�
9I �a0 ❑Y� ❑No
Nher tha spouse, indinte wBh wfwm
Is tlre P�PertY in QuesOOn: MnuaDy Aseesscd
�Ttea� Proaertv ❑ aimualy Assessed
"'___'—"
20 � 20
D�•a�t�er i\�0.. ���-
. .........
Card i\'O. ... ���3
/� ..... .
I�1VW.� ........
20 _ � 20 _
Signature ot Cow.ry AuAitor Caunry Date (month, daY Yea�
. T� —
I I We certfy under Ne penalty of pe � Nat Ihe ab e nd foregoing infortnation is true and cortec[ and tha[ the applinnt is a resident of Indiana afttl
owner I contract buyer of the aforemerrtioned prop n date appiiration is filed.
� Sig (owne h!1 name) Date (monfi, day, yea�j
r
`, msitlent address of apprrcant (number arid stiee( dty, state, and ZI e}
� c�. �� D
Puson authoi¢ea ey duty exewced Power of Attmiey or by IC 61.7-12-0.7 oa�e �monr�, day, y�a�
ACtlrnss of authom.ed person (number arM streef, ciry, slate, and Z1P tode) .
�
��