HomeMy WebLinkAboutMortgage_Gray+�'� STATEMENT OF MORTGAGE OR CONTRACT IkDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATIdN Coun gT�--o��w{nship Year
Y 57aU Fortn 43T09 (R6/5-08) � � � .
� ResaibeG by DeOMrn¢nt of Lod GovammeM Ftwica
lNSTRUCTIONS: MAY 2 �eZ�O�
To be frled rn person or by mail w8h !he County Auditor of the county whera the property is located.
Filing Dates: 1) Rea! Property: During the 72 months 6efore luno �1 0/ the yearlhe deduction is to be eNe�" ' e�„ �Q�
2f Mobi7a Homes assessed underlC 6-1.1-7: Between January 15 and March 2 of the year Oie dedLc6on��.��itective.
See reverse side lor additional insfruc6ons and qualr�cations.
GIBSON COUN7Y �
Applicanl (ovmer
- ses resi " ons on reverse side)„ y
_ '�i- `�t,Q
Key legal description
db- 3'0- �3 � . .SS-G�0
AssesSed value of real property as of Mortgage / ContraG indebtedness unpaid as
March 1, current year � March 1, current year
no, what is his ! her exact share of
If name on recard is different than that of
ot mortgagee or contrac[
Page n�mber �
f Is the applicant lhe sole legal or
owner? ❑ Yes � No
if owned with somaone other than spouse,
of mortgagee or contract seller (number and st�eet, city, state, 7j;;
of assignee or other owner or
Does appficant own property in any
county in Indiana?
20 �
P
S+gnature
in the amount
20 ��
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20 •9 � 20 20
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Counry Avditor
s uie pi
O�
whom.
O n+oh7e Non,e pc 6�.
Has this deducdon been reGuested on
property for wrrent year? ❑ Yes❑ No
20
i;i]
I I We ceriify under the pena�ty of perjury thal the above and foregoing informaSon is trve and cortect and that the appliwnts was / were
�sideyf of Indiana and owner of the aforementioned property on Mar�h 1, 20
or by 1C 6-1.1-12-.07
person