HomeMy WebLinkAboutMortgage_Martin"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
,. __ FOR DEDUCTION PROM ASSESSED VALUATION
• State Fortn d3709 (R77 / 6-09)
�' rresaieea q Deparonefq m in�al cwemment Frence
INSTRUCTIONS:
To be filed in person w by mail with tha CounryAWifor or Counry RecoNer of the counry where the pmperty is located. O
Fi7'mg Dates: 1) Real Property: Must Re durirg Ne year /or which the deduction is soughf.
2J Mobde /Manufactured Homes not assessed as Real Property Must h7e dunng the fwelve (72) months
6efore March 31 of each year the deduction is sough[.
See reverse side /or addrtional instn�ctions arM qualifications. �
ed value d mal qoperty as of
1, arma yeer
n no, what fs Itis I hr1 emrt share or interest?
�'fVV � o '�
Mort�age/ Contracc irde6tei�ress unpaid as W Mon
Mard� 1, at¢rst year aate
m �emrC u d.ReRnl tlan Nat o1 aPP��, 6Mifate bebw:
��:,yr.f .r:r..a-.-a�—i
Pddress of nnrnja9ce or cantraC se0er (nwnbe� and sbee4 �Y. ffi�e. ard LP code)
Name of as�p�ee w oiher axner w hddu of rt�ortgage
Ademss of assigtbe (numGrl and atreeL my. stata. end LP toCe)
GIBSON
� ��imyAuditor
❑ County Recorder
H wmeO wiN swneorre aher ihan spouse. 4Nicate with whan
Y �,e, C - — —, ..— - ,p.4�P�tJ L
mq,�r�;
r�.z�r� R
a,w�a � u� �,m or.
�_ , �
Sigtatlrte ot Camry Auditor
oTo�o - �/y,_3a
Counry
r eWitada oxlrelJ
❑ Yes ❑ No
Is the prapelly in puestion: MnueDy 0.ssessetl
❑ Real PmPenY ❑ !N^�!�1! �??�
EeGurflm Deen repuestea m praperty
nt year+ ❑ Yes ❑ No
�_ �_
Date (�+�, dey ��
I! We certfy urWer Ne penalry of perjury Nat the above and foregoing infortnation is We and cortec[ and that Me applinnt is a resident of Irdiana aM
owner / mntraU buyer of Ne afwementioned property on date apD����� � filed.
�reJu�2awnerS fiA reme) .,..,/1 O ', Date (nnnU�, tlaY. Yg�)
7 1 \
ss W appfitant (numbar ard sbee4 dN. �te. end LP mde)
,,✓. /O�S 5. F��f 3�u���-•
oy e�ey ��u�ea aa.er or nu�y or cr ic ��.i-�z-o.�
AOdres of aNha'¢etl D� (number arM street �Y. ��, and LP ootle)
�/ Y76
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