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��'�q STATEMENT OF MOR7GAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
.,1 FOR DEDUCTION FROM ASSESSED VALUATION
s.��;l�gn�, " State Form a3709 (Rit / 609) Gibson Johnson 2017
`' �� P2uribeO by DeDanment al Local �ovemment Finance �
INSTRUCTIONS: � 1 � ,Y.1 g.J 1,J
To be filetl in person or by mail. � Fortn 5lea wi�h:
Filinq Dates: 1) Real PropeRy: Must be completed and dated in fhe calendar year /or which fhe deduction is souqhl.
Must be filed with the CountyAuditor or County Recorder o/ the �county where the property is /ocated J L ily{�nty Auditor
on or befo�e January 5 0l the immediafety succeeding calendar year. Counry Recorder
2J Mobile /Manulacturetl Homes not assessed as Real Property: Must �le wifh fhe CountyAudifor o(the C
counry where the property is located dunng the rtveNe (12J months 6efore March 31 of each year the
deduction is soughL �
See reverse side /oradditional instructions and qualifications. GIBSON COUNTY AUDITOR
npqicant (owner or contreu buyer - see reshicuons on reversa side) ,
Michaet R. Melchior and Lynne M. Mechior
Ta�cing Distri Key number / legal des�ripiion � r��-� �, Record number Page number
G 2G23-11-200-002.309-024 Q,- �t y WN�SPtZ4wL Ca�S ad� � 33c� 3
Asussed v of real poperty as of Mortgage / Contracl inOebtedness unpaiE'as of Mortgage / ConGacl indebtetlness unpaitl as of Is the applicant Ne sole
March t, artan year March 1, c�rtent year � date of apd�� legal ar equitable owneR
�249,700.00 , 278,350.00 ❑� Yes ❑ No
f �ro. what is Ns / her azact share of interest? II v+med wHh someone oUfer Nan spouse, inEicate vriN »Riom
i
tt name on recwE is Gifterent Nan Nat of appGcant, indicate bebw. - Is ihe properry in question: Mnually Assessed
, Q Real Property ❑ MnuaOyPSSessed
Mobile Home (IC 61.1-7
Name of rtartgagee or oonbaa se0er
Mortgage Masters of Indiana
Address ol mortgagee w con4acT se0er (number and slrsef, ary, state, and ZIP code) '
7144 E. Virginia Street, Suite A, Evansville. IN 47775 '
Name of assi9nee w oNer owner w hdder ol mortgage �
Address of assignee (numbar and streel, city, state, and ZIP code)
Does applicant own pmperty in any oNer II yes, x�hat wunry7 What Ta�dng Distnd7 Has Utis deduction been requested on property
fnun inlnEiana? fwwrrent eaR
H ❑ Yes ❑� No Y ❑ Yes ❑ No
COUNTY AUDITOR
Deduaion approved in ihe amount of: �
20 20 _ 20 _ 20 I 20 20 20
�
Signature oi Counry nuei:or Caun,y Date (mon&, day. yeer)
C•
I/ We certiry under the penalry of perj that the abo nd foregoing informalion is we and wrtect and ihat the applicant is a resident of Indiana and
owner I convaa buyer of the aforemenlioned prope n date applicalion is filed.
� �wture (awnels ( name) � Date (monlh, day, year)
� . �
�� 7-7-2011
. u0 resiEent atltlress of applicant (numDer and street, ciry. stete, and ZIP crotle)
4129 E. Dogwood Way, Haubstadt. IN 47639
Person aulhwized 6y duty executeE Power o! Momey or by IC &1.742-0J Date (mon&, day, year)
Address of authorized person (number aM street. ciry, sfete, arW ZIPmCe)