HomeMy WebLinkAboutMortgage_Huey^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
� State Form G3709 (R11 / 6-09)
� � Prescibed by DepaRment of Laal Govemrtrent Fnance
File Mark
�urnucnoNS: F-
b 6e filed in erson or b mail with the Coun Auditor or Coun Recoider o/ the coun where the io � �'
P Y �Y N ty P PeertY is located.
Fding Dates: 7) Real Pmperty: Must file dudrg fhe yrearlor whicA Ne deduction is wughC � unry Auditor
2) Mo6ile / ManufacN2d Homes not assessed as Real Property: Must file dudng [he fweHe (12J monfhs ��� ��
bePore Maich 37 0! each year the deducGOn is sought. Go Recorder
See 2verse side 7or additional instruclions and qualifications.
App5cant (ox�wl{a�mnvart 6uyer- see resvil�iwu ar reverse stle)
ncsesced vaWe d mal propaty a d
MMfi 7. qamnt ymr
�il1O. W�Id� 6 �16 � hCf PSdfl 5�13IE O� VIiCRSI�
, GIBSON UNTY AUDITOR
—(7 l- I V — C7(� l. U 1 �•
ContraG "uWebteCness unpaid as of Mortgage / Cmtract uWebtedness unpaid as d Is Ne
ir�nt D� Cate of appGCation legal
W
�f OWI1Bd WIfi150RIC911E OIhC! i�12(15�OIISC. I(Id4iC �YII�I V1�10ff1 _
If Ildl�IC Ot1 fCWld 6 EAf¢Rll� U12n IIWI O( dO�ICdfIC YMIqt2 bCb"K.
«��
nqrtgagee or cantract seuer (numor� ana stree4 �1: state. arb Ln' aOe�
rvame ot assignee w omer awner w naoer rn mor,gage
AAtlress of assignce (number aM sveet �y. s+ate, and Z/P cotle)
Oces appli2nt pm yoperty in any oNer If yes, what
munry in Irqana?
Yes ❑ No
(
Deductim avP�`� � � amount oi:
20 20 20
`Mial Ta�a(g Distritl?
COUNTYAUDROR
20 20 _
Counry
tl�e sole
e ownen
❑ No
• O�� .......
pl•����cr��•'•�;' •..
• •���A ,o..•
Card�O• ••.....19� J
.�9a ,
� P�Y
❑ No
20 _ 20
Date (rtpnN, daY. Y�A
I/ We cer[ify u�er ihe penalry of perjury that Ihe above and foregoing infortnalion is We and corred and Nat Me applipnt i5 a resident of Indiana arW
amer�mntraU buyer of Ne aforemenuoned property on date applrca0on is filed.
70
erecuted Power UAttameY w �y IC G7.1-12-0.7
person (num0er aM sbeeG dry. state.