HomeMy WebLinkAboutMortgage_Polk"`n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,__ ., FOR DEDUCTION FROM ASSESSED VALUATION
Sta[e Form C3709 (R71 / 6-W)
,�«. ! PresviEed M��M o1 Loral GovammeM F�
ile k .
INSTRUCTIONS:
To be filed in person or by mail with Me CounryAuditor or Counry Recader of the counry where the ploperty is located. F� �� �/:I1
Filirg Dates: 1) Real Pmperty: M�st file dunrg Ne year for which tha deductan is soughG � V� Cd�Mt�JWditor
2) Mo6Be / ManufaUUmd Homes rrot assessed as Real Properly Must file dunng the lweNe (12) rtanths
belore Mamh 37 o7eacA yearthe deduction rs mughG ❑ County Reoorder
i
See feverse side for additbne/ inslructnons and qualificafions.
� (�`��`�b`��-� °�`� `��> GIBSON COUNTY hUDITOF.
Am � � �
��T" is rcm / legel desviption Reoortf rwmba Page w ber
�s��x �-,-��_ i�a -�oo-ooa. cai-a as� o o ���/
It rwne m RmrE ia C'il(uenf Nan Mat oi app�tant "cM�te Oelmr.
Name of rtnrtgagee a mntrxl se0er
AEdress d mortga9ce w rvntraU se0
s�:e.
PLEress of assiptee (numbe� eM 5deet �'+�Y• 57Hte. entl LP mtle)
Dces eppticant ovm yoperty in any oNer It yes, what munty�
munry in Ind'ana?
❑ Yes ❑ No
20 _ � 20 _ � 20 � 20
a
someo�
VJhat Tad�g District?
�
ss unpaiE as ot Is the appG�anl Ne sde
/�� kgal «eQUirame awnd)
W\J ❑ Ye5 ❑ NO
Is rt�e ProOertY'v� 0� �Y �
❑ Real ProPBRY ❑ Am��AY A�S=d
F
Po�K, �� M R
p�lUl D - �qs�
20 � 20 -
Sig�aWre N CoimN Aueitw I Counh I Date (rrarvh, daY. W��
I/ We certiy undu the penalty of perjury that the above and foregoing infortnalion is true and mrtect arW that the applirant is a resident of InEiana arW
owner / contracl buyer of the afwementioned property on date application is filed.
SigreNre (o fs NB^p^re) �i . � Date (rtmN, daY.Yea�
P�on authoraed Ey duty e�[ecuted Power a(Att�rt�ey w by IC 67.1-12�.7
/
AOtlress of auCwr'¢vi pe�..an (number aM streel, U�; slate, and ZIP ootle)