HomeMy WebLinkAboutMortgage_Adamson (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vea
__ - FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm C3709 (Rtt / 609)
� Pfesaibed by Departmen� o( Lncai Gm�emmenl Frerce
� 1�
��NSTRUCTIONS:
TO be filed in person w by mail with the CountyAuditw or Counry Recorder o! fhe counry where the property is located.
Frling Dates: 1J Real Properry: Must fde during the year (of whicA the deduction is sought. r�n I Counry Auditw
2) Mobde /Manufactured Homes rwf assessed as Real PropeRy: Must file dunng the tweNe (12) monm� p y 2
betae hlaich 37 of each year the deduct�on is sbught Counry Recorder
See reverse side !or adddional instmclions and qualifications. C��� m°"'� �-�
AppGranl (owner or m�y��uye�- see resnirmns on ve siden� V
` GIBSON COUNTY AUDITOR
Ta�ong DiStrirY Key n4mDer I legal tlesaiplion / Rewrd numbv Page number .
f//If��/II/C
A4CSSC4 VdhIC Of IP2� pIO�P,fIY d5 O(
MB�Ch 1. Plitll� yP2f
If no, what is his / Mr exa`3 share ot interest?
If ovmeC wiN mmeorie aher ttan spouse, ind"xate wBh whorn
�itade ameO
Yes ❑ No
II name m recoN is AiRerent Ihan ihat of applifant ��m� bzbH' !'� Is Ihe p�operty in question: MnuaOY Assessed
C C 1 S ❑ Real Pmperty ❑ Armually Pssessed
%�� 4J Modle i-brt�e PC 6
Name of inertgagec or contrarl seller ' ' _ ' _ _ . _._ _ _
Mdress o( mortgagee w mntraa seDer (number and sbae4 �M. ��. a� Z�P � ��� f�' �1� �
name or assignee w omer owner or nower o� mortgage
nooress o� arsgnee �numcer ana s�ree; ary, sra�e, am ur coae�
Ooes appinnl ovm pioperty in any oVier
counry in Ind'gna?
❑ Yes ❑ No
Dr�uction approveC in Ihe amount af:
20
Sigranue of co�aity a�aitor
�� -�1�5
COUNTYAUDROR
20 � 20 _ � 20
Couny
sted on property
Yes ❑ No
20 � 2b
Dale (monfh. daY. i��I
20
I I We certify unCer Ne penalry of perjury Nat [he above and Foregoing infortnatlon is true and cortect arW that Me applinnt is a resident of InEiare aM
owner I contracl buyer of Ne aforementioned property on date application is filed.
3��i�oers N0 7ame) �. • Date (nwcl�. daY. Yaar)
of appfidnt (numDar and stree( firy, state.
.. I oa�e I�,rq daY. rea�
Pdtlmss of authoraed person (num0e� arM street, ciry, sble, antl Z/P cotle)