HomeMy WebLinkAboutMortgage_Vanzo"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm C3709 (R77 / 609)
�' f PrewibeC Dy DepanmeM of Local GovemrtreM Finaxe
�STRUCT70NS:
k 6e Red in person w 6y maii wifh the CounryAudita w Counry Recorde� o/ Ne counry where the poperty is bcated.
F�7ing Dates: 7) Real Pmperty: Musf file dunng the year for which the deduclion is saughi.
2J Mobde /Manufactured Homes not assessed as Real Praperly Must file dunng the hveNe (12J monfhs F
6efore March 37 oleach year fhe deduction is swght.
See 2verse side !w additiona/ inshucGons a� qualifications. C
Appfitanl.(�wnerorcwitraa buyer - see resbi�on� on �averse vtle) _
v����+^��— -a..�-��— uc� -
ed vaNe d real pfopnity as W hbr(gage / Contract indebtetln�
t. artrn[ year Martli 1. Curtent year
If no, what 51ris / her e�U share o! interes[?
It name m r¢md ig diA¢rent than Nat o( aPP��4 tr�ditate bebw
2 � �,(',pYnly Auditor
��Counry Remrder
(J GIBSON COUNTY
Rem�tl num0er
�O� . 1 Sd —O J-
unpaid as of Mortgage I Conttact iMebtedness unpaid az d � Is
IJame ot rtnl4]2geC Or cOnRM1 seller (� � �/�
!J �-S.ti I' ✓`��C! ��� �
Address d rtnrtgagce or mntrad seller (num6er arcl sfrre4 �fY• 5afe. and LP mde)
name m asvgnee or ouinr owner w rmer or mongage
a�� as'sguncer ln'u-mcerano suee4 �1: seie.
wI� � . ,
Nit2nt wm in any o er
DeCUCtion approved in the amount of.
mrrieorie
DC�N'C[' �TO.....�� �.�....
c���a �io. ....��./..J7..k�?�.....
l �[�� (�% �/ � �U
wrt ttre sale
�itade owne(!
Yes n No
Is Me nY in 9ues0on: Mnually AssrsuE
eal PropertY � Armually P,ssessed
Mobile Hortie fIC 6
�l-�
Nis deEUCtion Oeen re0ueste0 m propcty
urtent Y�r r-i .. r-i
20 20 20 20 _ 20 2(1 20
SignaMe N CpimN nWitw Couny Date (�N, tlaY• Yeah
/'
C"
I/ We certfy under ihe penalry o( pe � ry that Ne � ve aM (oregoing infortnalion is true and cortect arM U�al Ne applitant is a resitlent of IrWiana arW
owner I mntracl buyer of ihe aforementioned pro rty on date appiin0on is filed.
Signature (oymyCghdlname) � � Dare (rtanC�, day, yeah
tlry, slate, aM ZIP mde)
.
Pddress of aW�arsetl person (num0er aM stree4 �Y. sbte, and LP mde)
v6�ST•o-o r