HomeMy WebLinkAboutMortgage_Bivin�
�
'^'�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
• FOR DEDUCTION FROM ASSESSED VALUATION
� n Slate Fwm 43709 (R71 / 6-09)
�' ,,,, i p��bed M cea�em m Loia1 GovemmeM Fmarxe
INSTRUCTIONS:
To be fiTed in person or by mail with the CowrtyAUditor or Counry Recorde� o) Ne county where the property is located.
Fi�tg Dates: 7) Real Property Must file during the year /o� which tha deduction is sought.
2) Mo6de / Manufactumd Homes not assessed as Real PmpeRy Must file dunng the hreHe (12) monfhs
befo�a March 31 of each year the deduction is sou�ht -
See reverse side /oradtlitional insfrucWns and qualificatkns.
IMOL�Uowneiarcontrxl6`bef-see mreversesite) ' .
!� ' �O� O �/J�
Y2al praprny az ot Mortgage/ Contraa 4
year Mamh t.curtentyear
iat Is his! her ezaG share of interest?
on �emrd'S 6.7erent Nan Nat of aPp6rani, trMLate 6ebvr
Name of mort9aBee w mntxt seller / 1 l V��y /l 3
lddrea of rtartga9ee ar mntract seDer ( a� ray, , ard e
Name W assi9nee or oth� awner or halder af mortgage /�
�/
Add`ess of assigtree (nurt�ber aM street, dly, state, antl LP aode)
Does aPpli�ant rnm pmperty in any oNer If yes, wha[ wunlyt
counrymlyd'ana? I"1 .,__ I"I .�_
DeEuction
20 _ � 20 _ '
Sig`uCrte W Coimb Auaaor
I/ We certiry u�u Ne penalry of perjur,
owner I contracc buyer of the aforementi
cH �.ln„w.�anF, ,a�w�a7 i . .
nmress
- (JOC�. �ZJ / —O�
�.s unpaid as ot Mortga9e f Con irM�
date of app �
tt avmed wiN someane oMer Ihan
0
� U` \�.....
D1':l\\'Cl \��" / �0......
�J
�:,, a �2`1���� � —
=�/n�...5�_._�_
e,.a���:��a,���
xd 7e� (numberaM sbeet �Y. staM,
�jqjyn}[y itor
CoLnFj�ecorder
GIBSON COUNTY
htedness unpaid as d� Is Ihe appllont the sale
legal w equitable mmeR
,�� ❑ Yes ❑ No
spouse, indicate with whom
k the Property in Question: MnuaDy As,esse0
�Rea� a.opeNy ❑ nrnuany wssessed . - -
Has Nis deductim 6een requested an Prope+ty
for artent yea/? � Yes ❑ I
_ 20 _ TO _
Date (rtnnth. daY. Yea�
�nd ihat the applicant is a resident oi Indana arM
Date (month. daY.l'08�
�