HomeMy WebLinkAboutMortgage_Pursell• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
Slate FOrtn 03709/R71 / 6-09)
, / Presaibed M DeD��M a1 Lmal Govemmerd Fina�e �
�.r
INSTRUCTIONS:
b be filed in person w by mail with the CounryAUditor or Counry Recorder o� Me county where the property is located.
Filing Dates: 7) Real Property: Must hle durng fhe year /w which Ihe deduction is sought
2) Mobde / Manufac2red Fbmes rat assessed as Real Property: Must Ae dunng the twelve (72) months
6efae March 37 0/ each year fhe deduction is saght.
See reverse side (or additbnal instrtncYvns aM puelilcaGor�s� �.
T � ����� (�I -3�-�03-000 • 303
A�sed raqie of re� poperty as of e/ Con IntlebteCn¢s unpaid az N Alortgage / Can:ror2 i
n+ara� �. am�c rear ��. a O aa� m eaa�w,
P-
tt ro, whal is his / her exad share ot intrlest? tt owned wiN saneone ofher tl
If name m recwtl is QAfrRnt than Mat of aPP��t M1dkzte EebM'.
Nama W rtnrt8a9ee a mntran se4er _ J
AOdren of morcgagee ar mntraa se�er (mmber end sbne4 �'dl: sbte. a LP code)
Aderess ol:
ooes epptx
muiYV in In
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3��
¢hei owrrer or haldar af nam+=-' � � '
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,o..aV_�..••"'
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pt���•cr �
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C�ia�� ..
�V
I I We cerUf� undel th�enatty of
owner I contract buyer of the afon
�l( l�/1 � / /�" '. _
Prlson authomtA M' duN ezewtetl
Pddress ot authw¢etl person (num
What Ta�drg D'aUict?
_.. �r
GIBSON
�Remia
..
6tedness unDaid as of I Ls Ne eP�l the sde
kgal p equdade v.mM
❑ Yes ❑ No
spouse, indirate wM wlwm
Is the property in Quesiion: Mnua�y Assessed
� Real ProPaKY ❑ ?,nn!u1�Y.A�e�ed . _ _
m p�openy
❑ No
zo_ zo_ zo_ zo_ zo_
Counh Date (rmrR74 daY �
-a8 -�c
Ne above antl foregoing infom�atim is We and mrtect and �hat the appliran[ is a resident of IMiana and
property on date appiication is filed.
antl slreet dN. �te. arltl LP m�
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Date (monfh. tlaY•