HomeMy WebLinkAboutMortgage_Scheller^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
__ , FOR DEDUCTION FROM ASSESSED VALUATION
� S�te Fortn 03709 (Rit / 6-09)
�' �«. 1 Presrn'betl M DePZrtmem of Local Govemmenl Fi�nce Fi� M
�TRUCTIONS: OCT a [a�fa�
w be filed in person w by mail wi(h the CountyAuditor or Counry Recorder of the coun where the ro F� �� ��
Fifi Dates: 7) Real Pio ry P�m ������ �
rg perry: Must file dunng the year for which the deductlon is sought. Counry Auditor
2) Mobde / ManWactured Homes not assessed as Real Property: Musf file danng fAe tweNe (72) months �
6efora March 31 of each year Ne deduction is sought. unty Remrder
GIBSON COU TY DITOR
See reverse side for addifionaf instructions and qualifications.
Appfr�(owneiorconvacfbuyer-searestr'rlimsmreversesCej _ �
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m�,�,�,�a
Y�
or ���n
Nartie of rriortgagce a�antact se0er
ot rtartgagee or mnbact seAer (numbe�
I/ legai desaiD� Remrd numbel
- a _ �DD -0D/, 7loS-D�� � �
Abrtyage / Contraa'ude6tedn�s unpaid az of Mortgage / ConYacl intleb�s unpaid as d Is N�
March 1, artrent year date of applrcation legal
DD
If axne0 wiN someone other Ihan spouse, iMimte wiTh wtwm
Name ot assignee or othu rnmer or hdder ot mortgage
o( astirynee (numberard sLee4 �'.
any
Deduction approved'm Iha amount of.
�
iitable o+meR
Ye5 ❑ No
�.'�o�' I5 Me P�DertY in puestion: MnuaDy 0.tsesud
eal Proa�v ❑ �^��N �ssed
hbdle Flome QC 61
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cify, sfate. aM ZIP code) '
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cK.�n:�vi_nUlYr�.
20 � 20 _ � 20 _ � 20
ot Cqmty AWiIOr
I I We certiry under the penalry �ury Nat
owner I wntracl buyer ot the mention p
Si9 (owne�S.Mlv 'f9.`1� _ n
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Fu0 resitlent addr�ss ol appfinnt (num0er antl street, dty, sl
/� 901 S, �D/ti.� Tree /�n
Pe�son authorrzed by dWy executed Power of Attm�ey w by
state.
Caunry
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e and foregoing infortnalion is We and cortect arM Mat Ne applicant is a resident of IrWiana aml
on date apqication is filed.
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