HomeMy WebLinkAboutMortgage_Ready (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co o Year �
__ _ a FOR DEDUCTION FROM ASSESSED VALUATION u' w
.. � State Fwm 43709 (R71 / 609) ,
1' ? p��ihetl 6y Departmen[ of Lad Govemment Fnance
"� File Mark
INSTRUCTIONS: � �
To be filed in person or by mad wdh the CountyAuditor or Counry Rew�der of the county where the pioperty is located.
Fifing Dates: 1) Real Property: Must file durrrg the year Por whicfi the deduction is sought. � � q' r
2) Mo6i/e / Manufactured Homes not assessed as Real Pinperty: Must fiie during the hvelve (72) months
before March 31 of each year Me deducfion is snught. � ty Recorder
GIBSON
See reverse side for addil'mna/ instructions and qualifirations.
AooG�ant (Cwner orcontrarl bure�- see r�stiira'ora on reverse siie) SO _
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as d Mor(qage /
Mamh 1, a
are or inieresr?
If name on record's dMerent Nan Nat of appGpni, mdinte below.
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irMehtedness unoaid as of
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Name af mortgagee w mntract seller w . ,
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Address of rrort9agee w cmtract seller (numbel and 5ree4 uN. �, aM ZIP mde)
w othu owner or hdder M rtwrtgage
Does apPlinnc own
counry in Indana?
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Person
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dry, state, and ZIP mde)
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What Tavng
Retotd number
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age I Cortvarl indehtedness unpaiG as U i
taPPOtation I
imeone other tha s� , �te wtth whoi
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�p�inm the sole
equitade ameR
] Yes ❑ No
Is ttie property in question: Mnually Assessed
❑ Real ProPertY ❑ Armualy Assessed
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GOUNTYAUDITOR � //
approvedmtlieamountot. Dra��•er 1T0. �:•
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zo Zo_ zo_ ca,�a �To. .. �.�r
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o co�u,rya,aao� „ camN
certify under the pena of perjury that ihe above aM foregoing infortnation is W e and cortea and that Ne applicant is a resident of Indiana and
) mntract buyer of the aforementioned p pe on date appficatlon is filed.
(owneh hAl rtame) /. / c Date (monfi. daY• Yea/)
resident ad�of`appfrcant numberaM 4 dry, state, a�Z1P�c
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auuwrrzea q� awy ezewcea aower orauaner or cy �c G7.1-iz-0.7
ressotautl�or¢edperson (numberandsaee4�+�Y.s+are,aMLPCOde)
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