HomeMy WebLinkAboutMortgage_Wilhite (4)""� STATEMENT OF MORTGAGE OR CONTRACT INDEB�1� ��'�+0 7ownsnip Year
; FOR DEDUCTION FROM ASSESSED VALUATION g
� State Fortn 43709 (R71 / 6O9)
S,u. � Presmbetl M DePartmen[ of Lacal Govemrtrent Fraxe
wsraucnoNS: OCT 2 6 2012 File Mark
To be filed in person or 6y mail with the CountyAUditor or Counry Recorder o/ the counry where th� ptopeqy;�sTp�eted. Form Aed wim:
Fi/irg Dates: 7J Real Pmperty: Must (Je durirg fhe year (o� which the deduclion is mught. ��� Counry Auditor
2) Mobde / Manuf2ctured Homes rrot assessed as Real Property: Must fi7e dunng the hveHe (12�moMLis
betoreMarch3lofeachyeartheded�ctionissought. GIBSONCOUNTYAUDITOR CounryRecorder
See reverse side for addifional inshuctions and qualifications.
iGa / legal
_��_�
M.a4re oF inal pfapgty a d
1. aerent year
It m. what a his / her erar2 stare of intuest?
o -c�oa. -oa
�a 4debtedness unpaid as W Moric�age / Con:r
� date of aoo�catin
1( name m remfd is Gittsent Man that al aPp&an4 cWipte 6ebw:
Nartre�� uaU sell � /�
e�' 02n
AAtl2ss W rtnrt[�agce or oontrap 5e0er (numbri arxl sheef, ctiy, sta�. and ZIP coQej
rvame o� awgnee or omer owner or ndaer a rtqrtr�aga
AdOfess ot assgnae (num6er aM alree; tlry, state, antl Z/P code)
Oces applinnt own property in any oNer If yes, wha[ munt7/1
counry in Indiana?
❑ Yes ❑ No
� /DSf_ //d ,
Drdumon appraued in ihe amount oY. �
20 20 29
tt awrreC wiN someone aher Ihan spouse,
Record numbel I Pane numbnl
Is R�e epp�nt Ne sak
kgal or equitade owndl
n Yes n No
Is the GbPenY in Vurstion: MwaDy AssesseE
�� RoPeAY ❑ Mnually P.�`sessed
Mobile Fiome fIC 61.
l.,�r��� m.�NEC.t 2
��-�!(��?y
20 _ � 20
Camty
Ei9
n C�nY
❑ No
FZ�7
1 I We certify under Ne penalty ot perjury Nat Ne above arW foregoing infortnalio� is W e and correct arid that the appii�ant is a resident of Indiana aM
owner I mntract buyer of the aforementioned pmperty on date appliqtion is fileG.
aM sLee4 pN. �te, a� ZIP ootle)
rc 13G� ��.�
Peison authorized Ey dWy executed
PdCrnss o(author'ved person (numDera�d strae; riry, state, andLPOOtle)
Date (montA, day, yea�
Date (monlh. GaY Y��
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