HomeMy WebLinkAboutMortgage_Pratt�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �
� State Fortn 03709 (R11 / 8-09)
�' ,.,� Presaibad bi DepartrtieM of Local Ccvemme�ri Fnance
F� e
INSTRUCTIONS:
b 6e filed in person w by mail with the CounryAuditor o� Counry Reco�der o/ fhe county where the properry is IocaN O V 9 F .
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Filing Oates: 7) Real Pmperty: Must file durrng the year lor which Ne deduction is soughG � County Auditor
2) Mo6�le /Manulectured Hanes rrot assessed as Real Property: Must Ae dunrg the hvelve (12J montlK, �nty Recadu
before March 37 0/ each year the deductiwi is sayhG � 0��6°''} "
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SeereversesidefivadditbnalinsLUCtionsandqualifications. QIBSON COUNTY A11D1
(ow�armmwaab r-see�3 mre�erse ' ) y
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�� T' Key nurtlber / legal desoiGiion Reto�d numM1 Pege number
�,2e��,.e a� - -�� -303 -c�oo. s3 a-oo alo 5 aY/
A�srssed vdue U real PW�Y ol A1ntqa� e/ ContraU'ude�teC�a unGaid as of Mortgage / Contraa mCebteE�xss unV� as d b tlre appkant tlia sde '
MarU 7, aneR Y� March T. a�rtent yrar dafe af aPP��b^ �°� �^�ae �
If �w, what is IJs / her emct
I( name on RmN e CAtuPl
' I It ovmeE wRh someone dher Nan spouse. uM'�te wiN wtu
below: Is Me W�CertY in 0uestia
�Real ProPeKY ❑
Namea(�ea«mntraCSWer '
�
Md(ess of mortgag� v mnVxt se0er (n�ariber end straeC �Y. sbte.
Name at asvy�ee or otl�er ownrl w holAer of mortgaga
MOress ot ass�fee (numOar enE aneet �: sfate. amf.��P cotlel..
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aaw�a h u,e amam� ar.
20 _ 20 _
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No
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20_ � 20
Yes Ll No
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penalty of perjury Nat Me above and foregoing infortnaUon is true and corteG arM that Ne applipnt is a residerrt oi IMiana ard
of Ne atoremerrooned property on date application is fileE.
Data (rm#h� da�: Yee�
(numbererW sLaeL
fuy n�ewted Power of Atmmey a by IC 61.
person (numDereiW sLee4 �; s/sle, anC Z
oa� ��. aar r�n