HomeMy WebLinkAboutMortgage_Meny (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u T Year
_ POR DEDUCTION FROM ASSESSED VALUATION 'I/
. _ • Sfate Fwm G3709 (R11 / 6-09)
�,w PresaibeE M��� al Loral Crtvemmenl Fu�ante
inurnucnoNS:
FEB jF'�e
To be filed in person w by mail with the CountyAUditor or Counry Recolder o/ the oounty where the property is bcated F� �� ��
Fifirg Dates: 7) Real Pmperty: Must file dunng fhe year lor which the deduct'an is wught. C��� un Auditw
2) Mobde / ManufaUUred Homes not assesced as Real Property Must file during Me tweA2 (12) months �
beforeMarch37oleachyearthededuclionissaght. GIBSONC UN AUD �ryR��
Sae reverse side (or additional insfixtions arM qualifications.
ApA(xant(awrrerw�traC6N'�-seeresviraaumreversesidi) I�.' _
-,.,,,,-„���_
piopaty at ot
her e:act shara o1 intrlest?
If nazne on rem�d is EiRerent Uun Nat af aPp6mnt, mEilate below:
r7ame a mor�jea or
Addr�s of rt�utgagce ar mntraG seuer (nunNer entl sbce; c[y, slate. eM e
Nany af assignee or other awner rn MNer W mor�gaga
nee�l"� � �%�J Lt7� �G'e aooea%
Dces apptitanl Own praperty in any oNU If yes. whal munq/1
muntyinlndiana? I"I ..__ I-1�.._�
Dr�uction approveE h� iha amount aF.
20 _ 20 _ 2q _
sig�nue d� 7C^amN.4wrtor
G' ! •
1/ We certify under Ne pena � of perjury that � above
avmer I contract buYer ot ih aforemer�9oned perty e
Si9p�4f�r��o, w�Pe�r'shNname)
f�u�resiE irc etltlress of appfirant (number and stree ry, state, a
95L.�ln F. �rep' �, ���
Pswn authoraetl M dWy exewtetl Attomey w
ME2ss W aWm�veE Derson (numDe�antlsbeet ciN. slata. end
� `SSa-oo� � o�
d es af Mortgage / CartraG mde6tedness unpaid az d Is ihe app�rani the mle
tlate of appOCation legal w epuita6le avmeR
� ❑ Yes ❑ No
tt owned wiih wmeorre other than spouse. iMicata with wMm
G '
NTd( Ta�dM
20
Me propnm� in Question: MrivaAy Assessed
�Keal ProPeRY ❑ MnuallY �
' — _'
Dr�,v�r 10...�.�.�61 I......... �
Card�O•...•4J.•�....... -
�93,�°� �
' ��— I p—
Date (norW. daY•Y��
arul foregoing intomiation is we and correa aM that Me applinnt is a resideni of InAiana and
n date applicalion is filed.