HomeMy WebLinkAboutMortgage_Persinger"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__,. = FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fam d3709 (R71 / 6-09)
�' u�. � . Presmbad by DePa�M ol Loml Govemnrent Fuarce
�Fil rk
wsrRUCnoNS:
To be fiied in person or b mail with (he Coun AWitw or Coun Recorder o/ the coun where the �� �� �� �q
v �Y b �Y P�PertY is located. �q �BMq
Filirg Dates: i) Real Pmperty: Must fi/e dunng Ne }rear /or which the deduclan is soughL Q T L� q�d��
2) Mo6ile / Manu/actured Homes not assessed as Rea/ Property: Must file dunng fhe hvelve (72J months
6efore March 37 o/each yearthe deduction is sought. ❑ Counry Recorder
See reverse side for additional insfruc7ions and qua/i�cations. "" �
Appfimm(ownero- 6vyer-seemsMrtionsmreve�siie) �_ ' GIBSON COUNTY AUDITOR
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/ Cantraa 4Webtedness unvel
Name ot �mrtgagee n contrau seuer (1 �
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Mdress W martgagee or cmtraG se�er (number and streeL �l: stete.
Name a1 asigncre or othel ovmer ar halder ot mort�a9e .
AGtlress ot asvgnee (number arH sneef, dfy, D�+���0
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IVUnt O�m WCPeM1Y
Irdana? �
Da�fuction appmveC in Ihe amount of.
sarneorie
az
Yes L� No
Is the property in QuesUOn: MnuaAyAssesuE
❑ Real RoPeKY ❑ M^uallY Assesud
Has �ha dedu�]im Eeen mVUesteE m P�P�Y
far wrtent yea/? � �
20 _ 20 2(1 _ 20 20 20 _ 20 _
Sig(anrte N CamN Auditw Counry Date (imn(h. CaY Y��)
I/ We certify uMer the penalry of perjury Nat ihe above aM foregoing infortnalion is We and mrtecl arM that Ne applinnt is a resident of IrWiana and
owner / contract buyer of the aforementioned property on date appfiration is filed.
S�p�a wTre/shNname) • Date(montfi.OaY,Yea�
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Fm� '�eent maress a appGnn[ (number and ureet �1: s+a+e�end z�a mde) w \
!V � ���
auUnmEd Oy dWy exewted Power of AllorneY a M IC 61.1-12-0.7 �� (^�'�W. �Y• Y��i
Pdtlress of aWior'¢ed person (numbereM sveet. firy, sbfe, aM ZIP code) .