HomeMy WebLinkAboutMortgage_Buehner"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co n own ip ar
_ � FOR DEDUCTION FROM ASSESSED VALUATION
• . . � State Fwm d3709 (R71 / 6-09)
� h�. d Prewibed Cy DePart^KM of Local GovemmeM Fuance
wsrRUCnoNS:
S E �'��""�`�`2009
To 6e filed in person w by mail wifh the CountyAUdifor or Counry Recorder o/ the county where the property is bcated. F� �� ��
Filirg Dates: 7J Real PropeRy: Must file durirg the year /or which the deduction is soughG ` �F� ��p(�'pr Auditor
2) Mo6de / ManulaUured Homes rrot asseszed as Real Property: Must fi/e dunng the fweAre (12) months �t
befora March 37 0/ eacA year the deduclion is sought �nty R�d �
GIBSO C uNTY AUDITOR
See reverse side fur additional inslructions and quali�cations.
�m(owner or coritrdG b see m rererse side)
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__. __._ ._,._..._..._a_.__w_. ..___.._..._ . _ ...._
o�-�� a�-ao-��-�oo-doo. ss3-oo� 09 as3
As�sed vWue d real prapelty as d Rbrtgage I Contract irdehtedness unpaid as N Mortgage I ContrazY inEe6tedness �mpaid as d Is Ihe appfimnt Me sole
Memh 7. firrer� yr.ar MarM 7. wrtent year aate o/ appGCabon legal or eQUitable rnmeYl
I l�{ DD O ❑ Y� ❑ No
II no. whai is ha I trer e�a share OI in}cest?
m recorC is tliRe2nt Nan that o( appOCant, InO�cate below
AOaress oi rtprtgagee «oontraG sWer (number a5fl street �Y.
V
Name of assignee or oNer owner or holder of mutgage
AdAresS Ot a5siiglee (nUmDar and stree; trty, sbte, and LP tot
any oNer � I( yes, v
o��a� �aw�+� � u,� a�,�u ae
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l
��� o� �ry�,�
i I We cert under Ne pena of p
. owner I ci traa buyer of the aforen
(ox.»/stu0nai e)
resitlenc atldress o�f Jappfinn um6er �
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�?ersnn auNO(rzeE by didY esecvicetl Power
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If avmed vrith someone ather Ihan spouse, 4Wimte with whom
Is Ne property in Question: MnueAy AtsesSeE
� (� �,1� � ��lZ � �`�,���� 1z
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Ihat ihe ahove arW foregoing in(ormation is We and correc[ arM Ihat Ne applinnt is a resident of IrWiana aM
ned property on date applicalion is filed.
state, and ZIP oode)
person (number aM saee4 �y, s+ate, antl LP code)
Date (im+ih. daY•
(rtmlh. OaY• Y��