HomeMy WebLinkAboutMortgage_Stamper (2)�
^'� STATEMENT OF MORTGAGE OR CONTRACT�IN�]EBI�DNESS Counl
._ FOR DEDUCTION FROM ASSESSED VALUAT�IS?N� ��
Slate Fwm 43709 (R71 / 6-09)
, y„ I presrn'be7 by Department of Local Go�mmrtrerR Finance
wsrRUCnoNS: OCT 31 2012
To be filed in persan w by mail vrith the Co�ntyAuditor or Counry Recorde� o! the county where the�pmperty is located.
Fiiirg Dates: 7J Real Pmperty: Must file dumg the }rearlor which the detluction is so,igM�� ��°'-''� '�
2) Mobde /Manufadured Homes rwt asscssed as Real Property: Must fiie dunrg the hv_eNev2J monfhs
6efore March 31 of each year the deduclion is sought.
GIBSON COUNTY AUDITOR
See 2verse side lor addifional insVUCt'vns arM qualifications.
Ap i( i or con7aa 6vyer- see rcstrfi�qs m re.erse sde) C� y_ �
TaAng
Key number! legal desaipfion
, �_�� „-�_
If rwne m remrtl is WRernnt Nan Nat o! appBcan4 md'ua� bebw.
Nartre of rtnrt8agee
Address oi mort9agee «
rity;srate,
streeG �l: stafi. erN
Oces appluant own yaperty in any o�her I If yes. what munt/?
munrymindiana? ❑ Ye5
❑ No
Deduction approved in Na artwun
20 _ 20
sgrewe or Cwn,ry nuatwr
�
File Mark
Form t�ed wnh:
County Auditor
Counry Recordu
1 Remid numCel Page numbu
- o a ao 5 9
ess unpaH as U Mwigage / ContrarY ude nass �mpaid as d Is Ihe appG�ant the sale
date of appGption lepal w epuitade o-xne(1
❑ Yes ❑ No
tt owned vriN mmeo� ottreJ tt�an spouse. irid�te with whom
Is DbPertYinOuesGan:MnuaOyAS,essed
eai RoPehY ❑ %����Y �
MoWle Fiome IC 61.1-�
ode)
— ao�a....
pra���er 1�•...........L
��9. �....
Card NO•� I'� ��� 7 l
I �
_ � 20 20
� 1 �
m n.W uesteE m G�nY
❑ Ye5 ❑ I
Date (monM,
20
I/ We certify under ihe penalry of perjury that the above and foregoing infortnalion is W e and correcY arid that Ne applitant is a resident of Indiana amf
owner I contract buyer ot ihe aforementioned pmperry on date appliralion is filed.
wnerY MI name)� Q� Date (rmrah. EaY• Y��
0
Date (month, tlaY. Yea�
of authorrzed person (number arrtlSLee; ciry, state, aM LP rode)
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