HomeMy WebLinkAboutMortgage_Bryant (2)_^�� STATEMENT OF MORTGAGE OR CONTRACT INDE�I�E� rownsnip vear
FOR DEDUCTION FROM ASSESSED VALUATION gf
• Sta[e Fortn C3709 (R71 / fi-09)
S 1 p��y�y py pe��nl of Local Govemment Fu�ance
�� APR 2 0 2012 File Mark
srRUCnoNS: F�,,, A� �,
To 6e filed in person or 6y mail with the CountyAuditor or Counry Reoorder of the county where ted.
F�7ing Dates: i) Real Property: Musf fi1e durirrg Ne }rear (or which the deduclion is soughL ''� � Counry Audimr
2) Mo6de / Manulactured Hortres rrot assessed as Real Property Must file dunng the tweNe ( s Counry Recorder
be(oreMarch3fofeachyeartheCeductionissaght GIBSONCOUNTYAUDITOR
See reversa side (or addi�onel instnicfions arM qualifications.
MP��� (owrier or uyer- e�resfir�auss m reverse #ide� ' ^ f� "' _ L
Asse�ed value d mal prope
Ma�tlrl.taa�era7Rar
tl no. what 5 h"s / Iw1 c�aC
If fwne on remd's dIIera
artentyeer
appfrant, rt�Aicafi Eebvr.
Name of rtmnga9ee ar mnttaa seuer �' �(3/
i /.
Address of rtnrtgagee n wntraa se�-' �S
Nameo(assl9�eo� ���� �
a
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�s unpaid as U
H owneE vriN someane
Reco�d Iba P�p9�nu��
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mdeMetlnrss unPaiE az d Is ihe ePP�m^t the sde
legal w equitade amM
❑ Yes ❑ No
han spouse. IMicate wiM w�an
1s the P�W�nY in 9uestim: Mnua%AssesseE
❑ Real ProPeKY � NmuallY �
Moh7e Fim�e IIC 61.7=.
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_.�q? VJhatTari�gD'atrid? Has�h's
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COUNTYAUDROR
I/ We certify under the penalrybf perjury thavll e above and f�
owner I contract buyer of the afaementioned property on date
$ig�uh�re (ownafs name) _ ,
� ��u ¢ �—
�I resMent aGdress appfranl numbe� and st+eet, tity, sfate, ard ZIP mtle)
O a-� o-� cu 1 oa � s F+-• �+
P�on eu� M dM'r�ecuted Power of AttcmeY m M �� �,.,-,2-0.�
AOtlress of aWrolaed pusrn (numDer aM street dry, sb�e, aM Z!P cade)
��esr�a a, a�m
❑ Yes ❑ I
20 20 _ 20 _ 20 _
Caunry Date (rtmth. daY. Y��
ig intortnatlon is we and cortec[ arM [hat the applirant is a resident of Irxliana aM
ation is filed.
Date (maVh. daY. Y��
y�[� f�8
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