HomeMy WebLinkAboutMortgage_Bruce (3)ry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yea
__ . s FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 03709 (R11 / 609)
�' ` Presaibad by DeVartment of Laal C.m�emrtrent F(wice
� Fil Ma
INSTRUCTIONS:
To be filed in person or by mail wiN the CounryAUdito� or Counry Recorder o7 the tounty where the property is located. �
Filing Dates: 1) Real Property: Must file during fhe yrear /or which the deduction is sought. (�Cf�� o Counry Audimr
2) Mo6�7e / Manutactured Homes nof assessed as Real Prnperty: Must fi7e dunng the fweNe (12}�nodtns� � � �
be(ora March 31 of each year the deduction is soughG County Recorder
See 2verse side for additional instructions end qualifications. ���
AD7�'� (owrar orcontraC buyer- see _ m 2verse side) .�/` , �
� • � a�-�s-a _
Asetse0 vah�e dmal papsty as of Mwtgage / Contraa u
Ma�d� 7. analt yPar MatCh 7, artent year
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rc �o. �� � n� i n� ��,ar� or �«�
It rartre on iemttl b S1Rerent tlun fhat of aPpOmnt, trd'uate hebw.
rlame m rtronqayea «ca,uaa sener �
s.6
Address ot rrongagee w cantrad snAer (number eM f, cdy, smte, aM i
Name ot assignea w other owner or hdder ot mMgage
AdC2a of assignee (numDer eM 51ree4 my. slate, antl ZIP code)
T w /-�w �`1-�-
Dces appli�ant ovm prop�+ty in any oNU If yes. what counyt
mmry m �naana? r'1 .,_ _ i"I .._
1�^I�:�'.
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1 I We certify unde(�fhe penalty of
owner I contraG buyer af ihe afon
I�W (oxne(thAfame) //
Pssm auNwaed M' CWY exeated Power
AdtlressotaW�o�vedpersan (num6eram
GIBSON COUNTY AUDITOR
Record num6er Page rwmCr+
- /�OD. 9`IZJ-c�0� a,D�n 53/a
I Cate ot appfiUtion I Iegal of epuitade owne(1
❑ Yes ❑ No
If wned with someone other ihan spouse. ud'rate with whom
Is ihe property in QuesUOn: Mm�a�y Assessed
[�eai �openy � nm,�nynssessed
r-�
W�al
20 _ 20 20 _
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the above aM foregoing infortnatlon is We and cortect
property on date application is filed.
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67.1-12-07
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