HomeMy WebLinkAboutMortgage_Dierlam"^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ ; FOR DEDUCTION FROM ASSESSED VALUATION � /
. . �� Stata Fortn C3709 (R71 / 609) y'-'� �/
S,,,, Presaibed by Departmerd of LoW GovemmeM Fuiarra N i
le Ma
INSTRUCTIONS:
Fortn �Ne,d, ,w!it�h:
To be filed in person w by mail with the CountyAWitor or Counry Recorde� oi the counry where tAe property is Iocate,d.E C 7�
Ffig Dates: 1J Real Pmperty: Must file dunng the year fo� which Me deduction is sought �) unry Auditw
2) MobAe / Manufactured Homes not assessed as Real Property: Must h7e during the tweNe (12) months ��ry Recorder
betora Ma�ch 31 0/ each year the deduction is so`yht.
i
See lEVBBe Slde (of 2l�tllilOnal InSiRIUIOns � quallflC2t10n5. ^ �6 � �
Apprwm(owrermcontractbuyer- re� B� � e) � GIBSON COUNTY AUDITOR
,� „ i n n A� M..
:l:�l
rw, what 4
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tt �wtre m ramN e Qdtuen� tlan tlia[ of appOranl, hWiote Eelrnr.
Name o( rtwngagea «mnuar� se0er
Aedres a� u mntract seuer (nwMer ene streeS ca
� � � y� �: v�������
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�
m�'
L'il
artaunt
20
aM LP code)
_ o -oav. 7�0 0
az of Mortgage I ConTart irMebteMess imP� as of ls Ihe
Eate a( aPP�� �
, vriN someorie other Ihan spouse, IMicate with wtwm
nlade awnrll
Yes ❑ No
Is tlre property in Ouesfion: MnuaM As.essed
❑ Real PmPeM1Y ❑ Mnually Assessed
Has Nis deduGian Eeen `e9uested m Pmpert�/
for wmnt yeaR ❑ Yes ❑ ��
COUNTYAUOROR
20 20 20 _ 20 _ 20
�n
ca� n.. Ioe�c�.�r.,��
I I We ce�fy under if� penalry of perjury �t the above and toregoing infortnation is true and correct arW that ihe applipnt is a resident of InCiana arW
rnmer f mntract buyer of Ihe aforemention property on date applicatlon is filed.
�reWre ovme/s fu0�mme� ��"" 0,, � Date (monfh, Eay, yaa�
�.I�nlfO(1 �����r'�' /.2-/7-/0
p revEem W appfrant (numbe�and sLeet m}; sfate, ard Z!P mde)
�5`70U E a5v .� �r,�ncr`sco, � 4�71�49
rwn auunr�a q dJr r,zewted vower ornum,er or M �c 67.1-iz-0.7 oate (mmR,, day: rsar)
tlress of aWmmEO Derew� (numbe� aM sbee4 �N. slate, anG Z!P code) .