HomeMy WebLinkAboutMortgage_Loyd, �
^•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yeat
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� �• State Fwm 43709 (R71 / 609)
. � � presoibed by Department of local GovemrtreM F�unce
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lSTRUCTIONS:
b be filed in person w 6y mail with the CountyAUditor or Counry RecoNer o/ the county where the property is located. F� �� �rt1�
FiNrg Dates: 1J Real Property: Must file dunng the year /or which the deduction is so�ght Q C 4❑ Zti7munry Auditor
2) Mo6Ae / Manufectured Homes not assessed as Real Property: Musf fife dunng the hveHe (12J months
6efora March 31 of eacA year fhe deducfion s sought. C r�ounry Recorder
See (everse side 7or adUdional inshuctions arM qualifications. �
np nt(ownerormwartbuyer-se�eewicnonsmreverseside) � 1^ lp GIBSONCOUNTYAUDITOP.
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T g DistruY,
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Ma�d� 1, armd yrar
If ro, what is his I her e�ct sha�e ot u
It name m femd s Eifrerent Nan iha
Name of rtnrtgagee or crntract seAer
Address of macga9ee w contrad seA
Name af azsignee or other owner ar t
Key rvunber / legal desuiD� RecoN number
a- _/ - o0-ooa. 0 3i - o�-S �oid-
Mpr[�age / Contract 4dnbteeness u�Pab az of Mort9a9e / Contract iMebtedness unDaiO as o( Is tl
Mart311, airtent year date of a7P�� �4
a-I�i �i/a
teresi? Ii owneC wiM mmeone dher n spou5e, @diCale wRh whom
Mant wm rynperty in afry ahel
���� ❑ Yes ❑ No
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Auditor
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irMicare Gelo�v:
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7antl LP
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If yes, what munt�?
caun
2(1 2�
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ves u No
Is N�e property in Ouestion: MnuaOy AssesuO
$Rea� F.operry ❑ /w,ualy Aueued
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I/ We certify under the penalry of'perjury that bove and foregoing infortnation is We and cortect and that the applirant is a resident of Indiana aM
owner I mntract buyer of the afaementioned perty an date appiiration is filed.
519rpm� (ownrh hd name) �/ vl Date (mmfi. tlaY• 1'ea�
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�� � t atldres. of appGCant (numbe nd sLee4 te. and LP oose) �
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Person autharizN Dy tluty ezecuted Pawer of At[pney w Dy IC 61.7-72-0. Date (rtpn(h, day, ysa�
Address ot authoraed persm (num6erantl sbeet �}: s+ata. and LP code) .