HomeMy WebLinkAboutMortgage_Hale (10)j-�o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I Township Year
i._�t FOR DEDUCTION FROM ASSESSED VALUATION I
���j $tate Form d3709 (RN / 6-09)
� PrescnEed by DeDartment of Local Govemmen� Financa
le a
INSTRUCTIONS:
To be lled in person or by mail. Form(fi�lea wiNf:1
Filing Dates: i) Real Property: Musf be cnmpleted and dafed in fhe calendar year fo� which (he deduction is sought. �UN �pi8 �� Auditor
Musf be filed with the CounryAuditor oi Counry Recordei o7 the wunry where the ploperty is located I LJ .
on or be/ore January 5 0( the immediarely succeeding calendar yeac C� nry Rewrder
2) Mobile / Manu(acfured Homes not asseued as Real Properfy: Must file with the Counry Auditor o/ the
counry where fhe property is lowfed dunng fhe rtvelve (72J mon[hs 6efore March 37 0/ each year the
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side (or additional instrucGons and qualifiCa[ions.
Applic�npl�n��'cnntra; D'uyer-s�ee�est�'tinonsarlieve e.�� /s�idae�,' 150. `. � .
.T1G. L..vl IN ` Y�.�� � C Y 1�,.{
Tau�9 District Key numCer / lagal tlasuipUOn I I Recortl number Pa e numDer
_ ;�u ,,.�,.� ,�i .��_i�_4nn�(1�� _M4�-11a.�h ,��11 ����
If no. wl�a� is
u reai a�verv �
Y�
ezaU share ot interest?
anentyear
I( nama on recorE is di.°.erent Ihan that ot applifant, intlicate Eebw:
`'}�GtY-4'iV� iE . �YecLa.�'iC1G
AGtlreu of mOrtgag¢0 or conVact seller (num0er antl sbeef. c�ry, sfate.
� W�QYY� .S* EUA�/i:
Name of assignee or ather owner or hdtler ol rtartgage
AOEress of assignee (number anC stree( ciry, state, and ZIP cotle)
Does apqifant own prapeny
counryinlnGiana? r
apD�iwtion
�f ownetl wi;� someane
as
ar equitade owner?
�Yes ❑ No
ihan spouse, iMifate wiN whom
�Is�h�e ropertyinquesUon:MnuaOyAtsessed
L''(Real Property ❑ MnuaOyASSessed
Has ihis tle4ucUOn Deen rapueitea on property
for wrteni yeaR
n Yes n No
� GOUNTY AUDITOR '
Deduciron appfoveE in Na artwunt of:
20 20 20 20 20 20 20
Sgnature af CounryAudi.or Counq I Date (monN, Cay, year)
I/ We certify under ihe penalty of perjury that the above and foregoing information is e and cortect and ihat the applicant is a resident of Indiana and
owner / conVact buyer of the aforemenlioned property on d te applicalion is fil
Nre ers h+tlname) 1 , �' � I Dale (m day, yea
(Y� 3 o�OI�-- .
Fu0 resiGent adOress o( ap ' nt (nvOmber and sLee ci , sfa(e. M Z/P eQod ) � , �� ����
-75b w s ±K.Lti•j'
Person auNOrized by Ouly executed Power of Attwney or by IC 61.142-07 I Date (monN. Cay. yea�
� ACdrass of auUar¢ad person (number aM sveet. ciry, sta�e, and 21P catle) .