HomeMy WebLinkAboutMortgage_Keil (4)^'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni
_. � FOR DEDUCTION FROM ASSESSED VALUATION
Sfata Fwm C3709 (R71 / 609)
,' Presrribed by Departrtierd of Laal GovemmeM Fu�ance
,.,.
INSTRUCTIONS:
To be filed in person w by mail wifh the CounryAuditor or Counry Recader o/ the county where the property is located.
Fil'mg Dates: 1 J Real Property: Must file durng the year for which fhe deduclion is sought.
2) Mobde / Manufaaured Hanes not assessed as Real Propelly Must file dunrig Me tweNe (12) months
betore MarcA 37 0l each year the deduction is swght.
See reverse side (or additionel insWClions arM qualifications.
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Y mal propeM1y es of
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Name o( rrortga9ee or mntrad Se9er
nearess or mortqaqce «cmaaa seo
Name N assiryiea w oMa owner m Y
�
UoeS eppuUnc own D�DenY �n any omer
munry in Ind"ana7
❑ Yes ❑ No
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CT[� �l�,m��
❑ Counry Record�
� GIBSON COUNTY AUDITOR
I� O— O�, Recortf numbPi Pa9e rwm0er
�� � Q/O `�
dehtedn�s unpaid as of Mortgege / ConYatt hWebieMess tmptiE as d Is Ne epp�xant tlx sde
tlate W appfi�tim legal n eQuitable axrnP
❑ Yes ❑ No
If owned with someone other Ihan spouse, 4di�ate with wlwm
IS C1C W�D�Y VI QIIPSL(Ifl: MIW2�`I ASSCSSlb
❑ Real PropeAy ❑ MnuallyAssessed
K�, !►aTR�.rt m
mrcrrnE� A
�oro-y�1,�9
Has ihis dedurdm Oeen re9uestea m p�opMy
kr artmt yea(t � Y�s ❑ No
iuc�an � in tice anoum at
20 20 20 20 20 `2Q ` � 20
_ — — -- _. — —'
riame d camry aiattw Camb i � __
I I We cert'rfy urWer the penalry of perjury that the above and foregning infortnation is W e and ca 1���+ //(/ /((1JAp, e�
1 mntracl buyer of the aforeme�rtioned Property on date appliratlon is filed. �ID C� ." ,� T�V'•C/
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I\ s� r W •t �aberanE sLee4 c6; state. and Z1P ootlaj J� J n e0. '�_ a9 - i o
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�on auuwraea q� exea,ted ao.er ornaanrey « ny �c G,.,-, z 1.� _ I Date_�rt..�.. _.. .--
MCress of aWrortreL persan (number a� sbeet, crry, stata,