HomeMy WebLinkAboutMortgage_Renee^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__, � FOR DEDUCTION FROM ASSESSED VALUATION
. � State Fortn G3709 (R77 / 6-09)
�` ,�,� � Presaibed GY DePartment of Local Govemment France �
Fle Mark
�rnucnoNS:
To 6e ned in person or by maB wifh the CountyAudiro� or County Recader o/ fhe county where the property is located.
FiTrrg Dates: 7) Real Pmperty: Must file durirg Ne year /or which the deduclion is wughL Auditor
2) Mo6de /Manufaduled Homes raf assessed as Real Pioperty Must file during the tweHe (72) months C�
be(ore Ma�ch 31 0/ each year fha deduction is sought ty ef
SeareversesideforadditionalinstrucfionsarMqu�7i�ications. GIBS C UNTYAUDITOR
P�sed veNe of real poP�Y as of -
�,.��
I( fq. wh2� IS hiS/ M( 0%2L7 Sh2fE Oi 1111Cf¢51?
tl rartie on �eco�d is dRfe�ait than Nat o( appl
of rt�ortgagee or rvnVari
O�—/ / ' C/1
Mortpage / Contraa u
Ma�ch 1, artent yeer
�Y•
Name of assignee w othrs owner or halder of mortgage
ACtlress of as4gnce (num6er aM stree4 �+N. state, and LP ootle)
Dces applimnt ovm pmperty in any oNer If yes, what munt�?
munN in Ind"ana? r-� ._ r-i ..
DeCUUOn
20 _
amount of.
zo _ � zo
zo
ff
PIL�
/_��1�11[�I 7
Sig�Nre of Counb Auditor �
I/ We certify urder the penalry of perjury Ihat the above and foregoing infortnatM
o.mer I contract buyer of the afotementioned property on date appiication is file
Sig�a;ure (owne/s hdl �arne) ��
1,1^ �a
_` Fu0 rev'dent aENe� of a mnl (num an0 sbect �; �ta. and ZlPmtle)
T 3 S r�e-c�Ur� N`-{il���
Pelson auUro`aed Gy didy executed Power o(Attamey w by IC 61.7-12-0.7
Atltlress of aulhor'veA person (numberaM sbeel, dry. stdte, an0 Z!P cade) .
S--7 Record number
� QP / ���
�e / ContraC' ebt unpaid as o� �s
ap II m� le4
%�J ' dU.
iBade ameYt
Yes ❑ No
PIU�CR% 1f1 QJp'iD0f1: /iIl(IW%iVSSKSLb
�al RoperlY Q Nulually A55e55¢d
m p�openy
❑ No
"___. ___�
Dra�r�er i1`0...���.� —
...
Card NO. ���.5
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Dace irtmN. daY.