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�'�o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I
.°i�l FOR DEDUCTION FROM ASSESSED VALUATION
S� ' State Fortn a3709 (RN / 6-09)
��• Presai6eE by Department of local Gwemmem Finance
�NSTRUCTIONS:
To be filed in person or by maiL Fon
Filing Dates: 1) Real Property: Musf be completed and dated in lhe calendar yearlor which the deduction is soug (��� � p 9
Must be filed with the Counry Audito� or County Recnrder oI the counry where the property is Ioc�bU � D L
on or be/ore January 5 o!(he immetliately succeeding calendar year. U I
2) Mobile / Manulacfured Homes not assessed as Real PropeRy: Musf fiIe wifh the CountyAUditor o�(h_e�, f�
county where the property is located dunng fhe nvelve (72) monfhs belore March 37 o7each year the -�
detluction is soughf.
See reverse side 7or aCditional instructions and qualifications. GIBSON COUNTY
AppGwnt (owner or confrdcf bvyer- see resMClbns rn reverse vCe)
JEFFREY WAYNE MAYBERRY AND CHERIE LYNN MAYBERRY
Year
County Auditor
Counry Recorder
PATOKA 2EOS31-200-003.818-027 � �V/�,L^;,��j
Assessed value U real poperry as of Mortgage / Canvact indebtedness unpaid as of Mortgage / ConVaG indebtedness unpaid as ol Is ihe apdicani Ne scda
h7arch 1. artent year Marct� 1. a�rtent year Eate of app&ation legal w equitable owneR
180,000 140,000 ❑� Yes ❑ No
II no, whai is Ns l her ezaU share of interest? I If owned wiN wmeone other Nan spouse, indicate with whom
II name on recorE R diPerent than ihat
DENNIS M DUVALL AND DEBRA A DUVALL
Name ol rtwrtgagee w conUact seYer
US BANK N.A
AEdress of mongagre w mnirad seller (number antl sveet, cdy. sfa;e, aiM Z/P code)
7550 AMERICAN BLVD BLOOMINGTON MN 55425
Name of assignee or oNer owner or hoWer o( rrortgage
AOGress o( assignee (num0er and snee4 �y: state, arM
�7oes applicam oxn property in any oNer
�mnry in InEUna?
❑ Yes � No
Oeduction approved in Ne amount of:
20 _
Sgna;ure of CounryAUEimr
20 � 20 _
What Tasing District7
COUNTY AUDITOR
20 20
questlon:MnuaOyASSessed
ry ❑MnualyASSessed
/�asted on pmpery,
/ ❑ Yes ❑
�
�
20 20
I/ We certify under Ne penatry of perjury Nat the above and (oregoing infortnation is We and cortect and ihat the appliwni is a resident of Indiana and
owner / conVact buyer of the aforementloned pmperty on date applica[ion is filed. _ �
� �i
ll aD�Yumber an sfreet crty, stafa, and ZIP ca
REED LN PRINCETON IN 47670
tluy executed Power of Attwney or by IC 61.142-0J
ot autMraed person (number aM svee4 dry. state, and
osn snoi z
Date (monM, eay, yea�