HomeMy WebLinkAboutMortgage_Seger^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ : FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn d3709 (R71 / 6-09)
S ! P2saibed M DePartment o( Lttal Govemment Fraxe
� File Mark
�STRUCTIONS:
To be filed in person w by mail wiN the CounryAuditw or Counry Recader of fhe cnunry where the property is bcated. N � F Ae
Filirg Dates: 7) Real Property M�st fde during fhe }rear (or whirh the deduclion is sought. Counry AuCitor
2J Mobtie / Manufactured Homes no! assessed as Real Property: Must fiie dunng the lweNe (12) months C��
before March 37 of eacA year the deductlon is saght. nty Recorder
See reverse side 7of additional instructinns and qualifications. GI BSON COU NTY AU D ITO R
MW n ownerortantrad,n�y�er-s sMUionsgqre�rsestle) . _
paperty as of MoRgage / Contraa'uWebtedrress unpaid as of Mortgage I Contrarl mtleMedness unpaid as of Is ihe ap�1 tlre sole
Mard� 7. wrre�rt Y� date of aGP�tan �gal or eWita6le ovme(t
❑ Yes ❑ No
H owned wiM someorie other than spouse. indicata wiM Mam
m remtd is tliRerent ihan �ha� at appGCaN. c�tl�te hebw. Ls iM property in Qursarn: MnuaDy 0.ssessed
❑RealPmperty ❑lvmuallyPSSessed
Name of mwtgagee
Address of rtnrtgagee a contracl se0er (nuMer antl streeR Wy, s+ate.
Name o1 assi9nee w aNer awner or ndtler ol mortgage
cdy. s/a[e, and ZIP tode)
Dces eppl�nt wm pfope.rty in any other I( yes, what wunty.+ NRat Taring Districl7 Has Iha dedutlion 6een repuestetl m P�Y
munry in IMiana? ❑ Yes ❑ No tor wirent yraR ❑ Yes ❑ No