HomeMy WebLinkAboutMortgage_Elpers (19)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Form d3709 (R77 / 609)
� � Preufibed Cy Department of Laal GovemmeM Firence
18 8f1C
INSTRUCTIONS: I��� 4
To be filed in person w by mail with the CountyAudifor w Counry Recorder o( the counry whe2 the pioperty iNG)62edJ fl� ��
Fding Dates: 1) Real Property: Must file during the year for which fhe tleduction is sought � Counry Auditw
2) Mobde / Manufactured Homes rrof assessed as Real PropeRy: Must h7e dunng the Rvelve (72J�monQi
6efore March 31 0l each year Ne deduction is sought Counry Remrder
See reverse sMe fwadditional instructions arid qualifications. GIBSON COUNTY AUDITOR
miownermm� N'e�' �ersesitle)
I Ta ' Distria Key number / legal esmp �� _/ dO I a D/ � y�^ O�� Record� umbu Pa�numDer
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va4c d mal propety as W Abrtgage / Contrati intlebt¢p�ress unpaid as of Matgage I ContraG i�Webtedness unp3iE a d Is the appfi�nt Ne sde
. Mertfi t. aaretV ypr AAamJi 7, artent ye2r date ot appGratnn legal w eQUitade ownef?
\ a1 � % �!'� %1 ❑ Yes ❑ No
wha� is ha I Mr ezad
It rwne m reco�d is tlitferent Nan Nat of appGcant uMifate bebvr.
Name o( rtrort�agee or contract si
/
Add(ess of mortgagec ar contraa
Name of assimiee ar ahe! owner
ray, state, aM Z/P code)
AdCress of astignee (number aM slree4 �y. s,ate, arM ZIP code)
Oces app(�m o.m property in any oNer I If yes. what muny.�
cwnty in IMiana?
❑ Yes ❑ No
awned wiM someorie dher ihan spouse. inGZate wilh whom
Whal Ta�a(g
Is Me property in WPStion: MnuaOyAUesseC
1=l Roal PfocertY_� Aflr1ua11yASSe55ed
\ � J 1�1 �'L �/ .
�-�9
0
GOUNTYAUDROR
De�uctlon apprwed'o� tlre amount of:
20 _ 20 _ 20 20 20 20 20
Sig�a ot Coun�Y nWiror Counry Date (mwvh. tlaY. Yea�
�-T �
I/ We certify under ihe penalry of � ry lhat the a v and toregoing infortnalion is W e and corted ard ihat Ne applit�nt is a resident o( InEiana aM
owner / wntracl buyer of the afwe errtioned pro0e on date applicadon is filed.
Kre(owneY� /WI rertre) Date (montA. day, yea�
�'utl ent address W appfimnt (n Derand sbeet 1Y. sbte, and ZIP cotle —
3 -1- -7
Person autho'aeG Dy OWy ezecuteA Power of Attomey or Gy IC G1.1-12-0.7 Da[e (rtronN. tlaY yea�
Pddress of auNa¢ed person (numDera�d sbeeG dry. ua(e, an0 LP wtle)