HomeMy WebLinkAboutMortgage_Rexing (12)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C,'un To i Year
__._ ; FOR DEDUCTION FROM ASSESSED VALUATION
: . State Fortn C3709 (R71 / 649)
�,�,. j Presaihed hy Department af Laal Govemment Fnarce
INSTRUCTIONS: U��'F�¢ QJarW,09
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To 6e lled in person w by mati with the CounryAudita or Counry RecoNer o! the county where the property is located. �� m� ��
Filing Dates: i) Real Properry: Musf !de durirg the year for which the deduclion is soughL s �t�, q�d�t�r
2) Mobde /Manufactured Homes rwt assrssed as Real Properly Mus! fiie during fhe twelve (72) months
6efom March 31 o7each year the deduction is �ht. nty Recorder
GIBSON O Y qUDITOR
See reverse side for additionaf insLUCtlons and qualfications.
MP�rant (owneroye�t�ct buyx�'see f�svn'mns aj(evzne srje)
� 1. amnc Year
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�i M� W�Id� 6 f16 ��121 f
�illdliM Ofl IBWId 6 dli
Name m rtnrtgagee «
��-Z - iod-�a.�/3-aa;�
of Mongage / ContraG iMe6tetlnPSS unpaid as W Mongage / Conra�2
PA2fch 1. Qlrrenf yeer _ daln karv+G,�=eM—
Address W rnortgagee w mntrad seDer
ownerorhdEerotrtqrigage
stete,
Oaes epplimnt axn property in airy oNer
counrymin0ia�7 ❑ Yes
❑ No
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If yes, wh+ /
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I/ We certify uMer Ne penalty of peryury Nat Ne above.
owner / contrad buyer of the aforementioned property ot
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_,( .dlN. slafe. \a�m
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�ey a Cy IC 6t:
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�/ C.� 3� S" D D, �"°
Mtlress W auCmr¢ed person (numEer antl street, aly, sbte, an0 LP mde)
"�c�9 — .59/G
etl a ot Is Ne eppluant Ine Sde
' legal w epuitade wmeR
❑ Yes ❑ No
31C Wl�h WllOrtl
y in 0��0�: /+�nuaM Assesse0
aeM ❑/��M�
!im Deen re9uesied m P�Y
n ❑ Yes ❑ No
zo
��aw, eaY ,�n
ri is a resident ot Indiana arM
monfh, day, yba�
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