HomeMy WebLinkAboutMortgage_Bane"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
= FOR DEDUCTION FROM ASSESSED VALUATION
, n Sfa[e Fwm 43709 (Ri1 / 6-09)
�� Presaibed by DepartrtreM ot Lo�al Govemment Fuwre ,_
,a. '
INSTRUCT70NS: rF
To 6e filed in person a by mail with fhe CountyAuditor or Counry Recorder oI the counry where the propeRy is located. 1.���� ��
Fdirg Dafes: 1J Real Property: Musf file dufig the yearlor which Ihe deduction is sought County Auditor
2) Mo6ae / Manufaduied Homes not assessed as Real Property Must file dunng the twelve (12J months .'�_
6etore Ma�ch 31 0l each year the deduction is sought � b R�°b�
See 2verse side foraddtional instrucfions arM quali�ications. GIBSON C i r`
Appfranl (pvorcrw confraG buye�- see resbirb"ons wy�verse sitle) '
/ GL p7(o—Cl.�� U/— UU .
Asessed rdue d real poper,y az ot Mortgage / ContraG WehteOness unCaid as
MarM 7. ament Year Ma�ch 1. afrent year
I( m, what is his / her exaO share ot interesl? I} w
It name on �emN is tlilternrt Nan Nat al apP�nl, md'vale belovr.
Name of rtprigagee or mntra�Y seller ��
C
Address of mort9agee a aintracl seAer (nurtibu ar
Name W assignee w otlrer owner or hdder of morrc
MOress of assignee (num6er arid shee4 �rtY, state.
Does applimn[ ovm property in any oNer
muNy in IMia`a?
❑ Yes ❑ No
I.!�I�:�Td
Zo _ , �
If yes. what count�t
�
VYhat Taritg DisUict?
2a _ , za
sigrenne d Camb nua��r I caunty
I I we certify under the penairy ot perjury Nat the above a� foregoing infortnalion is true and corte
owner I contracc 6uyer of the af«eme�oned property on date appiiration is filed.
� FWI reqdent aGdress of appGrant (number enC� 4�: �te, aM LP ooCe)
a 83 /✓ Benc��maik /J/� �/i�ICPf(lr
Peison authoraetl by duty executed Power a! Ntwney ar by IC G7.1-12-0.7
Pdtlress of autho�'nEd person (numberarM svee4 �1y, sbte, aM LP code)
�17G70
number Pag nu
/ �a�
ts of Is ihe appfront'
� w ewnaw
❑ Yes
spouse, IMK'ate wM whom
Is iM P�PPrtY in Que50on: Mnualty Assessed
❑ Rea� arovertr ❑ ,�w,ualry nssessed
bfobile H«ne (IC 6
Na � been re9uested m P�Y
�� � ❑ Yes ❑ I
.r��, a Rc� K� �
/02 - yF3ro
oa�e cm«,u,. e�r. r�n
No
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