HomeMy WebLinkAboutMortgage_Cummings (2)^'n STATEMENT OF MORTGAGE OR CONTRACT NESS Coun 7ownship Year
__ = FOR DEDUCTION FROM ASSESSED VALUAT � g;
..• S�ate Fortn C3709 (R11 / 609) �
� Presrnbed by DepartrtieM of l.anl GoremrneM Fnarke
File Mark
uvsrRUCnoNS: DEC 7 2011 F���w
b 6e filed in person a by mail wdh fhe CounryAuUitor or Counry Recorder ot the county where the perty is bcated. �I� V��,,
Filirg Dates: 1) Real Property: Musf file durirg the year for which the deduction is sou�L�. N� � __unty Auditor
2) Mo6i/e / Manufactured Homes rrot assessed as Real PropeRy: Must h7e dunng the N� 72) montAs
before Maich 37 0( each year Ne deducfion is sought v ❑ Caunty Remrder
GIBSON COUNTY AUDITOR �
See reverse sida /of additional jr�huctions and qualifications. / '/ . _
������o�
i, Gr�¢!II yna.
what's his / her eract sha�e o( interest?
11 na�rie m rem�tl is
rtiortgagee or contraU sr�er
.3cb-000. ��-UdY I,.�„�,�„ � f
�udeCtednPSS unpaid as of Mortgage I Contraa indebtedness unpaid az d h
�l'9ar �"� .-./Fl tlateof.GPGption le�
ACdress W mMgagee w tanbaU sedrl(nunber w-' -._, 1�N, stafe. aM ZIP code)
�rn�� v-.
Name oi assiow-� C
V �� V^�� 1
� � �-5(��0
De _.�.ar.
20 20 20
Sig�Me imr N _
samearre dner tlan spouse,
county.� � wha� iarin9 DistriU?
I! We certify uMer �he pena�ty oi perjury th�t Ihe aDOVe arW
owner / mntrad buyer of the afofementioned pmperty on da
^J
�
AOEress of aulhorrzed Pe�^ (numbe�aM sOee(. alY. sbfe.
�
20_ � 20_
Counry
Y� u No
Is Ihe P�GQrtY in Cuestion: Mnually Asessed
❑ Real Roperly ❑ Mnually ASSened
Fias Oi5
for curR
r�
Date (rtqNh. tlaY• Yea�
m piaperty
❑ No
r�
infortnation is W e and cortect and that the applicant is a resident of Indiana and
ion is filed.
Dare (rtmN, day, yeer)
�n