HomeMy WebLinkAboutMortgage_PierceJ/
/
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
.r—
: FOR DEDUCTION FROM ASSESSED VALUATION
.• State Fofm 43709 (R71 / 6O9)
•S � presrn3ed by Department of Local Govemment France
File Mark
INSTRUCT70NS: �a,,
To be filed in person or by mail wiN the CountyAudifor or County Recolder of fhe counry where the pmperty is located. �D�� �
Filirg Dates: 1) Real Pmperty: M�st file dunng the year for which the deducfion is mught � Coun Auditor
2) Mo6Be / Manutactured Homes rrot assessed as Real Property: Must file durrng the hveNe (12) months
before Ma�ch 37 of each year the'deducfion is sought. Recorder
seereversesideloradditionalinstructionsandqua�i�rations. n GIBSON COUN
Ao86rantfox�rerwaonfraC9we�-seem.sUicbnsmrevermsidel // � � .
Assessed rdue d r� pfoprfty as W h
Ma`di 1. aursd year h
rc m. wt�at Ls nis � rre. exaa share or inieresc?
tt name m reaW is dAtrrnnt tlian �hat ot aPpWan�
Name m mongagee «ca,�aa seuer
. /YYl L
amress or morc9aqee «ca,aacc sener (nurnms ar
Name of asignee or othu ovmer or Fwider af mori�
Addr�ss of assignee (number aM stree; riry, state,
di�nt own property in any other
Indara? ❑ Y�
Deduction approved in ihe amount oF:
,�
SigreMe of Caimry �mr
1�R7
o-o�U3- �JDo1, ,
/ ContrarS 4de6tedfmss unpaid as of
ciry, sta:e, aM LP oode)
a�J� ._W.ao i 3 ..�_.._..�
/ ConvaC inEebtedness unPaid as ot Is the aPG��� Ihe sde
�fi�cu/�� (�1r legal or epuitable wmrll
tv/ � �/ �,--y � ❑ Yes ❑ No
H awned wi� someonb oUw1 ihan Spo�ae. itfd'xate with whom
couNn nunrcoR
zo _ i zo i Zo _
Caunry
DroPeNY in Questim: Mnually AsscsseO
e�a�oaenv ❑!!�,!,�niass�sea
- i tr+.,....w •--., '
� �5��.�
�
- �P�iU `}'a. ��`�Y
_ Tc��c�. �.m`�-k�
I/ We certify under ihe penaliy of perjury that Ne above and foregoing infortnalion is We and cortec[ arM that Ne applirant is a resident of Ind�ana and
owner / contract buyer of the aforementloned property on date application is filed.
�rqwre (ownrh fidl remej . Date (nnnUi, daY• Y�/)
(numberantl stree4 oTy stare, aM LP mtlej
Pe�san
ACtlress of authorae0 person (num0er arM sbee; tiry, stata, and LP tade)
C