HomeMy WebLinkAboutMortgage_Pollock (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES Coun Township vear
___ .; FOR DEDUCTION FROM ASSESSED VALUATION
State Form C3709 (R7116-09) -
�' wr f Presaibed by DeVartmenl of Local Government Frence
File Mark
� srRUCnoNS: JUL 3 1 2 �,�w;n„
To be filed in person or by mail with the County Auditor or Counry Recorder o! the counry whe2 the pioperty is located.
Fil'mg Dates: 1) Real Pmperty: Must file during the year /or which the deducGon is soughL C.�J, County Auditor
2) Mo6Ae / Manufectured Homes not assessed as Real Pmperty Must file dunng fhe fweNe (12) months
6efore March 31 of eacA year the deduction is �ht. County Recorder
See reverse side /or addrtional instructions a� qualifications. G I BSON COU NTY
AooGran o rofconlydCbuyar-seerestric(ion$.Qn2verseside) /
T��o��i � la�
P.ssessed vahie � real P�P�Y � d
Mamh 1, axrenl yrar
I( no, what a h's / her exaG share of inteiest?
If rwne on record is d'AFerent Nan ihat of app[
Name of mwtgagee or mnbad seller
legal de�aiplion
-�,y-�oa -000
i`qipte bebvr.
Address of mort9a9ce cr anhact se��er (numbel aM streeG ciry, sfate, arM ZIP code)
owner or holder of mMgage
(number arM shee4 tlry, sfate, ana [//' cme)
Does aP�nt ovm property in any dner
counry in Indvna? ❑ Yes �
Deaucfion approved'c� 1he amount oE
xo _ zo _
Signanrte of CamN nWitor
If yes, whal munyl
No
I p I
a � -�
I as Of Morl
date
If ovmed with someone other
COUNTYAUOROR
in7ebtetlness unpaitl as o� I is tne apprcsm me sae
legal w epWla0le axneR
❑ Yes ❑ No
han spouse. iMkate wXh whom
h Me property in QuesUon: Mnualy AssesseO
❑ Rea� P.oaero ❑ amualN Assessed - - .
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Counry
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I/ We certify u�der Ne penalry of perjury that Ne above and foregoing infortnalion is we and cortect arM that Ne applirant is a resident of Indiana ard
owner I wn4ad buyer of the aforementioned property on date application is filed.
.__.._ ,_..__.�. wn......,e� _ Oate (monfh. day, year)
1 ad`C�ress of appG�nt (num6Br antl(she¢t, tlfy, slate, antl [IY OP
S7 1�✓ CO lG[ M O•�i � SJti7��
rofaed Gy duy executed Pov.er af AtlomeY � M IC G7.1-12�.7
yuthor"¢¢d person (numbe� aM stree; tlt}: sYafe, arM ZIP cotle�
Date (monN, Cay, yea�