HomeMy WebLinkAboutMortgage_Deno"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ + FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Form C3709 (Rit / 6-09)
�,� Presaibed by Department of Loral Govemment Rnance
File Mark
�S7RUCT10NS: O C i
mn fi h:
6e filed in person w by maB wiN the CountyAuditor or Counry Recorder ol the counry where the property is located.
Filirg Dates: 1) Real Pioperry: Must !le dunn Ne ear /or which the deduc�ion is so ht.
2) Mobi7e /Manufactu2d Nomes irot assessed as Real PropeRy Must m dunng the tweFve (72) months ��' unty Auditor
6efore March 31 0! each year the deduction is swght. unry Recorder
Seereverseside7oraddtionalinstrucfionsandqvalfications. GIBSON C
itT ii!S �
/ liw e�mG shara of interest?
'15�—/ti-/�/—nOL
Alor(qage / Contrarl'ude6tetlness unpaid az
Ma2h 7, curte�t ye2r
It narne on remrC's attfrJent ihan that W aOP�M. ifMirate Gelovr.
Name of rtrutgagee or mnvaG seller
�/3
Addrea of rtqrtgagee or contraG se0er (n and streef, rdy. sbte, arrl LP oode)
Name o1 assgnee w other ovmer or halder of rtqrtgage
AAC�g assgnee (number aIM stree; tlry, 51afe, aM Z/P catle) /
4� Q�vvnl� 9� /1,r,✓ .�-a-�x
Does aPPtipnt ow*� property in any other If yes. what munt�?
Eate of appfmation
numCrl �
kgal ar equitade uwne»
❑ Yes ❑ No
if owned wiN someo�re other Ihan spouse, indinte wiTh whom
Is Me P�oPertY in puestion: MnuaM Assessed
❑ Real Rope�ty Q Mnually Assessed
--rn��--����E vE,uo
A N1`lr� G
/ l � L/�/�iS
COUNTYAUDROR
DeEuction appravad in Iha amount oE �
20 20 20 _ 20 _ 20 _ 20 _ 20 _
Signanne ot Camry ATuditor Counry Date (nnvN'. 0ay, Ype�
/
I/ We cerlify uMer Ne penalry of perj Mat Ne above foregoing infortnalion is We and mrtect arW that the applinnl is a resident of IrMiana arM
owner I contracl buyer of the aforementioned property date apPlication is filed.
� Sigratlue (owneYS me) _ Date (month, day, yaa�
Full revdent address of appGCant (num6er antl sLae " state, nd ZI cotle)
Y s St � LGe
Pason authorized Gy dWy ezewted Povrer of Attorney rn by IC 61.1 2-0.7 Oate (monlh, day, yea�
Pddress W auNatreC permn (number aiA sbee; tiry, state, antl LP aoda) .