HomeMy WebLinkAboutMortgage_Fischer (2)'°� STATEMENT OF MORTGAGE OR CONTRACT�ID��� un Township Year
� FOR DEDUCTION FROM ASSESSED VALUAT�IIN
Slate Form 43709 (R77 / 609)
`,w P�esrnbetl by DepartmaN of Ln21 Govemment Fitwrce
wsrRUCno,vs:
OCT 2 4 2012 File Mark
b be hied in rson or b ma�7 with the Coun Auditor or Coun RecoNer of the coun re� F� �� ��
pe Y b b ��te tha`oaem is bcated.
Fifing Dates: 1) Real Property: Must fi!e durirg the }rear /or which Ne deduclion is sought (� \ ��unty Audimr
2J Mo6de / Manufactured Homes rrot assessed as Real Property: Must fiie duAng the h�eN�2) months
6etaeMarch3lofeachyearNedeductionissought. GIBSONCOUNTYAUDITOR ❑ CounryRemrder
See reverse side lor additional insfructions erM qualifications.
T' Distrct KeY nunber / le9al CesaiPtion
-�- -a �a -
A�¢sed rahc oFinal poperty as d Abrtgape / Contract irdebtetlness unpaitl as d
Mm�h 1, armla Yrar Ma�th 1, curtent year
0o d
11 ro. what Is h's I her eraU share of inteJesfl tt owr�
tl rwr�e m recad is d�Eerent Nan that of aPP�t hd'aate bahv`
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AAdtess of nartgagee v contract seDer (num6er end sbeet ciry. slate, aM ZIP oode)
Nama o( asv9nee w oNer oxner
F�G�
state,
prope�ty in any oNu
❑ Yes ❑ No
zo _ � 20 _
w Co�mry awrtor
If yes. wha[ counry? I VJhat T:
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- couNrvauort•
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Rem�d �wmbu Page wmbel
- ao i 9
Ba9e / Conva-i trbebtetlness unVaid as d Is Me ePW�t Ne sde
ot appOtation legal w equitade ar+wYl
❑ Yes ❑ No
someone
spousa,
tM properry in 7uesUOn: MnuaOy Assessed
]jteal RoPertY Q Armualh� Pssessed
Dra�rcr NO..°� l �.....
�����.o. ..1..9.. ��.5........
��, Ot�. �
,�d
n propelty
zo
I I We certfy under the penalry of perjury that the ahove arW foregoing infortnation is W e and corte�l and that the applinnt is a resident of Irdiana a�
ntract buyer of e aforemerttion property on date appficatlon is filed.
`�re (o ers hN nertre) . Date (monfi, daY. Yge�)
�rn � Zk�> io-�N- iA
II �ctiAent of appf t(numDer and s4ee4 dN, state, and LP qoQe� .
Per�..on authaaee
person (numberaiM sLaet �+N. stata, eM LP code)
Qate (rtprvh. tlaY. Y��
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