HomeMy WebLinkAboutMortgage_Dowdy"•� STATEMENT OF MORTGAGE OR CON� �T�� Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VAL T
• State Form 43709IR71 / fr09)
,` ,,,, , Presaibetl by DePaM�N af L.oral Govemment France
�sraucnoNS:
FEB 2 6 2013 File Mark
Fam t�ed wiih:
To 6e lled in person or by mail wifh tha CountyAUdiror or Counry Recorder of the�Q unty where the propeRy is located.
Filing Dates: 1) Real Pmperty: Must file dunng fhe year for which the deductio� ($�ought. � Counry Audimr
2) Mo6ile / Manufactmed Homes rrot assessed as Real Pmperty: }Vl�Pib twelve (12J months
6efore Maich 31 oleach yearthe deduction is sought�IBSON COUI�TY AUDITOR ❑ Counry Recorder
See reverse side fnr additional instrucUons arM qualifications.
r ' DisfiG KeynumO�llegal
J ,'
Asessed ralue of reaI WopenY az ot Mortga�,
Maitli 1, aQmnt YP2r MarCh �
L
If ro. what is his I hw erart 1�am of interest?
If narre on remE s diRefafl than ihat ol appB�ni, h�dib
Name of rrotgagee w crntract se0er
�L(.) � LC� —O
/ ContraG intlebtetlness unpaid as of
(numbereMshee4 ��y, state, arW LPcode)
or oiher omrer or lalder of mort9age
Maress ot assgnee �nl�mcer arm suee4 ary: s+a:e, arw ur coae�
Oces eppliprit arm property in any oNer
munryinlndana? n ��
20
Sig�anrta ot Camry
amoum or.
Recrnd number Page numOri
� o
:htedness unpaid as o( Is ihe appGnnt Ne soie
legal a eQURaNe owneR
❑ Yes ❑ No
If OWIICE WIN 50If120f18 OI�12! GHfI5P01152.
COUNTY AUL
�$ UQ pfOpQlly III QIIC511qf1: i1111W'd�f �
❑ Real RoPertY ❑ %+�II1��Y �=�
MoWle Hame OC 6
, ,,p I l
la"e` �0 ,,.
� � ���.a.o.. a
� C�l��p3�'�.6�
20 _ � 20 � 20 � 20 _
Counry
20
��P�Y
L] Yes ❑
Date (monfi. day,
2[I
I I We certify under the penalry of peryury that the above arW foregoing infortnaGon is We and corteG and Nat the applinnt is a resident of Indiana and
owner I contracl buyer of the aforementioned property on date appiicatlon is filed.
�"�re � �� �� �, — Date (month. EaY. Y�a�)
uecuted Power af Attnney or Cy
aaaress m aw,«aea ce� (�umber aiM sbee4 �}; state,
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