HomeMy WebLinkAboutMortgage_Riley (5)"�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__„ : FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Fortn d3709 (R71 / fi09)
S � PrescribeE Dy �epartmenl 01 Lowl Govemmenl Frenca
�� 1�8
iSTRUCTIONS:
b be lled in person or by mail with (he County Auditor or Counry Recorder o/ fhe county where the property is located. F� �� �q�� 9
Fiimg Dates: 1) Real PmpeRy: Must file during the year /or which the deduclion is sough[. M Y� gyShly Auditor
2) Mo6ile / Manulactured Homes not assessed as Real Praperty: Must fi/e dunng the tweHe (12J monfhs
before March 37 0/ each year the deduction is sought C� nry Remrder II
See reverse side (er additional inshucfnons and qual�cations.
nppfirant( raconvae6uyer-seere � m rsesve) GIBSONCOUNTYAUDITOR
T� Oistrict Key ber / �egal EesaiPtion Recofd munbrl Page numbu
4- l n�—..,,,. � �__� �� _ � 9 � o0 oao �i 7.5 - oo I
�
iat rs na / Mr e� sl�a�a ot Inte�e5l"!
m rem�d 5 EiRerent Ihan Nat o( aPP�^�. uWicate bebw:
Name W rtrortgagee ar con�seT
\
AddRSS of nartgageP w conVact sn�er
Name of assignee w other wmer or hd
AEEress ot assignee (num6ar arM sI2e4 �1: �te, ano t�r 000e�
Does applrent o+m poperty in any olher If yes. what munty?
munry in InOiana? ❑ No
❑ Yes
rtnrtgage
aa IrWe6te0ness unpaid as of Mortgage / ContraC mde6tedness unpaiE az of Is ihe appWanf Me sde
yrar date of appfication legal w epultade ovmeYi
I 00 � ❑ Yes ❑ No
If owned wiM sonieane othu Ihan spouse. iMirate wiTh xirom
Is ihe WoPeRY in Ouestion: MnuaOy Asusse0
� ❑ Real ProPerty ❑ �?�!uiallYfssessed . . .
��.
Oeauction apptoveC v� itre amour�[ of.
20 _ 20 I 20
Sgrawre d CoimN nW itw
C�T
I/ We cert'rfy under Ne penalty of rjury that Ne
owner I conVacl buyer of ihe afommentioneA pr�
NTaI Taritg Distri
2�
;
Drawer i\`0.��.��..
Ca rd i\'O. ... % .in.3 ........
� �5, oa�. °`=
and fomgoing infortnalion is we and cortect arM ihat Me apqimnt is a resident of Indiana and
i date appliption is filed.
riry, state, antl
Person autharized OY tluty exeated Power of AtlomeY a M IC E7.7-12�.7 - I Datc (monN. day,
Pdd2ss of autha'ned person (number and sLee4 ciN. state. antl Z!P rode) ^l � .