HomeMy WebLinkAboutMortgage_Roos"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
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. FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn G3709 (R71 / 609)
S ? Presmbed by DeP��rd of Laal GovemrtreN Fumnce
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�STRUCTfONS:
b 6e filed in person w 6y mail with fhe CountyAuditor or Counry Recorder of the county where the property is Iocated.O C T f '�'
Filing Dates: 1) Real Property: Must �le durirg the year for which the deduction is soughG Coun Auditor
2J Mobde / ManuFactured Homes rrot assessed as Real Pruperty Musf file during the hveNe (12) monthsC .�. ry
6efora March 37 of each year the deduction is saght. unry Recorder
See ieverse side (oradd'rtional instructions andAualificafions. GIBSON COUNTY AUDITOR
�AOdinnlfn»nerorconhartbuyer-seeresfnrlions rere�msidal
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what a his
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Mrtgage / Contract inde6tetlrress unpaitl as of Mortgage / Con� inEeMedness unpaid az d Is �he applirant the sok
iCh 1, curteM yeer date of applitation le�al w equliade ow'ne(7
/ n s� n i� ❑ Yes ❑ No
If reme m remrE "a NRerent ihan Nat of appi'icant, 6difata 6ebvr
Name oi mortgagee or mntratl seller
naares or rmrte�9� «rv�,vari
oWnHM
5
sveeG �: sfale.
sameorre aner Inan spouse,
ACCress f asvgnee (rwmber and sGeet �'pY. sfefe. entl Z/P mtle)
T L-� 3�-3- /,oa�lC,
Dces apptifant wm pmperty in any dher I( yes. xfial muM/.+ VJtat Taring De
CouNy in Ind"gra?
❑ Yes ❑ No
Deduction aPWw� ui IM amount af:
ZD 20 20
slarawre of CamN Audwr_
20
Is Ne property in puestron: MnuaDy Assessed
❑ Real RoPenY ❑ �����Y ��
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�oos �\
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20 I 20 I 20
daY. l'2a�
1 I We certify under the penalry oi p6/7ury Ihat the ab anG foregoing infortnalion is true and mrrect aM ihat ihe appluant is a resident of IrWiana and
owner I mntracl buyer of the afo(ementioned pro on date appliptlon is filed.
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(numDer anE stree4 ary, state, antl ziP code�
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Pelson autlro�¢ed Gy dWy executetl Power NAttcmeY � M IC 61.1-12-0.7 I Date (mon�h. daY. Y��
Address of authoraed person (numberaM sLee4 �}: state, and ZIP code) .