HomeMy WebLinkAboutMortgage_Gilles^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ • FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm d3709 (R71 / 6-09)
�' � PreSaibeE M�«M o( loCal GwemmeM Finante
w.
wsraucnoNS:
Fom
7o be lrled in person a by mail with the CounryAuditor or Counry Recorde� o7the counry where the property is located.
Ftiirg Dates: 1) Real Property: Must fila during fhe year for which the deduction is soughL [FB 1 7 �
2J Mo6Be / ManufaUUred Homes rqt assessed as Real Property Must file during the fweHe (72) mo`Ahr
befora March 37 of eacA year the tleduction is sdght.
c.�.
See reverse side for additional insfixlbns and qualifications.
np�m(o»rerlm1no-aabuyer-seam_micnon3mm�ersAstle)n �_ . � GIBSON COUNTY
)")
ed vehc d rral PW�Y ��
7. ar�eN year
KeY mmber / legal d�iptim
6 �
^ Mortaage � convaa'v
hta�d� 1 wrtem year
W�13� 6 �1LS � ilEf B10f15�INB Oi YI}tlCSI�
It �me m iemrtl is �rterent ttan
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Name m assgnee w ame! ovmer rn rnaer m mongage
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wy sm:e. a�a
nnafass o� assgnee (numoeraro svee4 �Y, sm+e, ena ur cme�
Doe� applimnt own poperry in eny ofher tt y�s, what
munry �n �manaT r� .. r� ..
- ol- 9/ 9-0 �-'
iess unpaN as N MMpaga I Contra
tlate of eppACatim
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tt owned with sommne other Ihan spouse� trd'zate wiTh xMm
ship Year
If�(
riih:
Counry Auditor
County Recorder
�—
ITOR
Page number
�, y
re eppBranc t�e mle
J or W�ItaEle owne(1
❑ Yes ❑ No
Is Ue DroPenY N Ouesbm: MmiaBy Assessed
L'�� �xro ❑ ��N�
Dra�ver NO"...�.� � �
Card ti'O. .....°.?��..........
� 1�3, coo.:%,
COUNTYAUUROR
De�ucCOn aPW� In tlre amount aF:
20 20 20 20 20 ' 20 20
Sig�ture W CamtY AuEitor Couny Da[e (nonfi. daY. 7��)
C'
I/ We certify under the penatty oi rjury that ihe a e anA foregoing infom�alion is We and cortect aM fhat the appiicant is a resident of Irdiana aM
owner I contract buyer of the aforementioned pro on date applicadon is filed.
� Sigfa9ire (o�mefs /ull name) Date (rtmtl�, dsY Yme�)
1Y �Si9.aA�
WI �esi0ent adtlr�s af appfirant (numDer antl street. cily, sfate, ard ZIP ootle)
I �t-� . v.b ��. S N
Person authoraeE Dy tluty executed Power of Attomey w Dy IC 61.1-12-0.7 Oate (monlh. day, yea�
Mdress of autlromed person (number and street, fi(y, slafe, antl ZIP ootle) .
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