HomeMy WebLinkAboutMortgage_Davis (17)_"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
, FOR DEDUCTION FROM ASSESSED VALUATION
S�ate Fortn d3709 (R71 / 6-09)
S,.,, � Resaibee Ey Departmerrt m Low Go.emrnent Finarca
1NSTRUCTIONS:
To be fiied in person or by mail wffh the CountyAUditw or Counry Recorder of the county where the property is located.
F�i'mg Dates: 1) Real Ploperty: Must file durirg the year for which the tletluctbn is sought
2J Mo6de /Manulactu2d Homes rwt assessed as Real Pruperty Must fiie dunng the tweNe (72) months
befwe March 37 of each year the deduction is sugh[.
See reverse side foraddifionel insWClions and qualifications.
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Name M rtiwtgagee ar conttaU seYer �
Addrais d rtnrtgagee ar mntraa se0er (nwnber ar
Name o1 asvgnea wWro awner or hdder W morq
nnaress w asseF�ee c�um6er am so-xt �: aa,m.
0023 B�fII OWII plOpGl�' Y18f1Y Otl1Gf
munty in IMana? ❑ Yes ❑ No
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❑ Caunry Recorder
GIB$ON COUNTY AUD�TC�c
Record numOer Page numCPi
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❑ Rea� �oaenr ❑ rv�uanr w�d
4Met Taurg Disvict?
Deduc7on appiv+eE in Cre a � j
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zo_ Dra�verlO•.....•�t�........ •
�,��c�,ry�� Card ir0•� O���ca�
I I We ceruty uMer the pe �� 9 � � po . �
owner I mntraG buyer ot t -. _-. ��w.
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Full resident addres^. W
Pr�son auttntaeE hY duy euewted PotGer o( AttcmeY w al IC 6
PdOress ot aWmr¢ed per'..on (numberantl speeL �: sbfi. en0
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H25 p14 dl'�UCIIMI �BCfI fCQUES}p1 M PIOpCf:J
for wrtent yea(.� ❑ YPS ❑ No
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�e and mrtect aM that Ne apptinnt is a residerrt of Indiana antl
Date (rm�tl�. QaY.Y��)
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