HomeMy WebLinkAboutMortgage_Miller (11)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN� Coun 7ovmship vear
-._—..
FOR DEDUCTION FROM ASSESSED VALUATION
. n State Fortn a3709 (R71 / 6-09) �
�` - Presaibetl by OepaRrtient af Laml Government Frence
File Mark
�srRUCnoNS: MAY J 2012 F«,,,A�a,„m,:
To be frled in person w 6y mail wiN the CountyAuditor or Counry Recorder o� the county where the pioperty is located.
Fil'mg Dates: 1) Real Property Must file during the year (or which fhe deduction is sought. C.!� � Counry Audhor
2J Mo6de / Manulactured Homes rrot assessed as Real Property: Must file dunng the twelve (73j rtwnt �unty Recwder
6efore Ma�ch 31 of each year the deduction is sought.
Seereversesidelo�addyenglinstrucdqnsarrdqualifications� n _ GIBSON COUNTY AU
Key
as d
�
tt ro. what'a his I her e�U sAae of interest?
If name dt lecortl s tliRerent N3n Nat ot appfr2nt, uidinte b21o'//.
Nartre M mortBa9ee a mntract seller �
neeress ot rtwngaqee « mrio-aa senu (nu,Nei end sbeet �y; s
Name W assignee w otlrer owner or hal0er d mutga9e
ALEress ot assignae (rtumber aM sl+ee4 �Y. �. � ZIP catle)
Does applic
muMy in In
� Di-a`�•ei� \0...`.. �� �..........
20 _
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Card NO. ....J:.�.l............
� I(�,�SSo.co
Counb A�Witor
-� �. 3��-�a
rress unpaid as W Monga9e I(
sortiea�m
NTat Taa�y Distrirl'1
��OUNTYAUDROR
24 _ 20 _
Counry
Reoortl m0u Page numbu
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�. cWebieCnnss un0� as d Ls Ifre aPP��t Ne sak
kgal or equilaNe o�m�i
❑ Yes ❑ No
ihan spoum. iMicafe wflh wha�
a me arovam � a�sum: n,��u,aur a�s�e
❑ Real PmPertY ❑ M^!�M � . . -
Fias N's tleduction Deen re9��� �^ P�rtY
� w�� � ❑ Yes ❑ No
�_ zo
Oate (rtqnfh. day, yea�
I I We certify under the penalry of perjury Mat the above and foreguing infortnation is We and cortecl arid ihat the applipnt is a resident of Indiana and
owner I conVact buyer of the aforementioned property on date appiication is filed.
exewted
autnoraed person
�n0 shcet dry, styate, an
�fPP%� GSfS
o(Attm�ey w by IC 67.
cdy, state.
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