HomeMy WebLinkAboutMortgage_Dicus (2)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
_ • FOR DEDUCTION FROM ASSESSED VALUATION
� Siate Fam 43709 (R71/6-09)
S' y,. � Prrsafbed q' DePa�rd af Lacal Cwvemrtrerd Firwice
INSTRUCTIONS:
To be fi7ed in person w by mad with the CountyAUditor or Counry RecoNer of the couniy whefe the property is located.
Fifing Dates: 7) Real Property: Must fi!e during the year for which the deduction is sought.
2) Mo6�7e / Manufacfured Homes rrot assessed as Real Property: Must fiIe dunng the hveNe (12) months
6efwe Mamh 31 of each year the deduction is sough[.
See reverse side (or ad�itipnal instructions and qualfiptions.
w"' �l
Acsessed rdlue of 2al p'aperty as d Mortgaget/� yCfo�n1�t
Mard� 1. ameM yPar M2�G� t' V
It m. wfiat is his / her exaC share ot interesi? '
I( name on rem�d'a NRemnt Uiar� thai ol aPpGranl, cM'uate Gebw:
rtwngagee or
Add2ss ot mortga9ee ar mntract seDer (num6rs and sbee4 �Y. �te, ai
Name of assi�nee or oMer owner or hdder of rtwrtgage
fWCress of assignee (number arM shee4 ury. stNe, aM LP code)
Does aPDlinnt wm property in any oNer If yes. what mur
munry in Ind'¢na? r-� .. r� ..
m Ne artrounl of:
20- - � �- � �-
3 Oo0 _?o �-Od
dehtedrress unpaid as ot Mongage / Conv
tl awned wiN mmrofre
pS � S ��sc�.
ia-.���8
�
Year
8arriv Auditnr
L 111 L"
counry Recardu
GIBSON COUNTY AU TOR
Recortf n Page numbrl
�
iess unpaid as d Is �he ap� nt e sc
legal w equitaWe avm
Yes L� No
spouse� friaxate x�in wnom
Is tlre P�GenY in aues�an: MnuaMAsscssed
❑ Real RoPenY ❑ ��!�Y �
on been re9uesteE m P��Y
_ � 20 _
�reNre of CO�mfl Auditor I wunty I Da[e (rtmth, daY. Yea�
I/ We certify under the penatty of perjury that the above arW foregoing infortnalion is W e and mrtect and that ihe applicant is a resident of Indiana aM
owner I contract buyer of the aforementioned property on date appliration is med.
�qanue (ox�/s fi� rertre) _ . Date (monM. daY.1'aa�
authoraed Ey Euly ezewted Povrer of Attorney or by IC 67.7-12-0.7 ' \�� Date (mon�h. daY.
_ _ _
; of aNhu¢ed prJSOn (numberaiN s�ee; city, sta[e, en0 LP mtle) .
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