HomeMy WebLinkAboutMortgage_Bryant"'� STATEMENT OF MORTGAGE OR CONTRACT ��T�E� oun Township Year
: FOR DEDUCTION FROM ASSESSED VALUATI j
�• State Fortn d3709 (R71 / 6-09)
�' r Presaibed by DeparimeN o( Lacal Govertment Fnance
�NSrRUCnoNS:
AUG 2 2 2011 File Mark
To be filed in Y N ty ty F°m' mad with:
person or b maii vrith the Coun Auditor or Coun Recorder o7 the wun &au�dYMR��Zl�located.
Fdirg Dates: 1) Real Pioperty Must file durirg Ne year /or which the deducfion is soughl. � �ounty Auditor
2) Mo6i7e /Manufactured Homes rrot assessed as Real Property: Must fiie dunrn� the Iwe �1p hs
before March 31 oJeach yearNe deduction is saght GIBSON COUNTY U'I u� ❑ Counry Remrder
See 2verse side for additional instrucUons and qualfications.
ADP��t (ownerar _r- see resLicfiuu or{r�Cyersr�,jide) . � � . 1.
1 Key num0er / I I desaiption Q Record number Page numbrr
l2 �_ �-as-3oo-d�d� ��8-oa ao �l 3y �
Y� pfoperry as o! . M e/ Contrars iMebteO�ress unpaid as d Mwtgage / Contraa'vMe6tedriess unpaid az d Is Ne eppG�ani Ne wk
ypar r date af appli�tion legal or epuhade rnvneR
� G ii � ❑ Yes ❑ No
H name on mcwd's tliRU¢nl Wn Nat o( aDP���. �inte belovr
Name of rtwrtgagee a conuact seller
a cantrac�
awner
sta:e,
AdGress ot assignce (numberand stree4 clry. sfefe, entl ZIP catle)
Oces aPplicant ovm yoperiy in any oMer IF yes, what muntYt
county in IMiana?
❑ Yes ❑ No
zo i� i�_ i 2a
I/ We certify under Ne I
amer I traa yer �
7�anue o y
.�
m ` ent aEtlress of appGc
�.
rwn auNOmeO EY dWy ezE
' 3U3 7 S' _
IGress of autlro�"¢ed person
mmeone other Ihan spouse. iM'rcate vrith wMm
Is the property in puesfion: MnuaDy Anesse0
❑ Real ProP�Y ❑ %��N �
Mohle I-brt�e !IC 6
,�,T� grn�1��o�J^� �
�lT' ` ` ^
\UDROR
11\ V �
r�\ c� �,oc�s:-Q
���ab�a�.� ���
�,rv ��1- 3�1y�
�ueSteA m pioperty
� Yes ❑ No
�
Mat ihe above aM foregoing infortnalion is W e and cortect aM Nat the applipnt is a resident of IrWiana amf
ned D�ocertY on date appluation is filed.
�ntl dti slate.2MZIPOd
I/"
of Attarney or by IC 61.7-12-07
n/_ �/ i n C.� .
'sbee4 ciry. sYdte, aM LP code)
`=��'a- �
monN. daY. Y��
-z� _i.